Colonoscopy with biopsy
Facility: Medicine Lodge Memorial Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,476
- Cash Discount Price: $1,665
- vs. Medicare Baseline: 1.21x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $1,222.56 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Tricare | $1,145 - $1,522 | 94% |
| Humana | $1,301 - $1,729 | 106% |
| Aetna | $1,323 - $1,900 | 108% |
| UnitedHealthcare | $1,358 - $1,805 | 111% |
| Hpk-All Plans | $1,358 - $1,805 | 111% |
| Medicaid / KanCare | $1,430 - $1,900 | 117% |
Consumer Guidance & Cost Commentary
For the Colonoscopy with biopsy procedure at Medicine Lodge Memorial Hospital in Medicine Lodge, KS, the cash price is $1,665, which matches the facility's median paid amount. This cash rate is significantly higher than the state average, as indicated by a ratio of 1.2 times the Medicare benchmark of $1,222.56. While commercial insurance plans like Tricare, Humana, and Aetna negotiate rates ranging from $1,145 to $1,900, these negotiated amounts often exceed the cash price. Patients with high-deductible plans or those who have already met their out-of-pocket maximum may find paying the cash price directly more cost-effective than relying on insurance, which could result in higher allowed amounts after deductibles are applied.
To minimize potential costs, patients should proactively contact the hospital to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront. It is also important to request a full itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. If a patient receives a surprise bill from an out-of-network provider, they may be protected under the No Surprises Act, which bans balance billing for emergency and non-emergency services at in-network facilities. Always verify your specific plan's deductible status and network coverage before scheduling to ensure you are aware of your financial responsibility.