Colonoscopy with biopsy
Facility: Stevens County Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,864
- Cash Discount Price: $2,143
- vs. Medicare Baseline: 1.52x 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 |
|---|---|---|
| Humana | $793 | 65% |
| Aetna | $817 - $2,143 | 67% |
| Blue Cross Blue Shield | $1,295 - $1,364 | 106% |
| First Health - All Plans | $1,929 | 158% |
| Wppa - All Plans | $2,036 | 167% |
| Medicaid / KanCare | $2,143 | 175% |
Consumer Guidance & Cost Commentary
For a Colonoscopy with biopsy at Stevens County Hospital in Hugoton, KS, the cash price is $2,143, which matches the facility's gross charge and the state's cash median. While the facility is in-network for six payers, including Humana and Aetna, the negotiated rates vary significantly, ranging from $793 for Humana plans up to the full $2,143 for Medicaid/KanCare. It is important to note that for patients with high-deductible plans, paying cash upfront may be more cost-effective than relying on insurance, as the negotiated rates for some commercial payers exceed the cash price. Additionally, patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees.
The facility's negotiated rates are notably higher than the Medicare benchmark of $1,222.56, with a ratio of 1.5 times the Medicare amount, indicating a markup typical of commercial pricing structures. Although the facility is a Critical Access Hospital owned by the local government, the median negotiated payment of $1,864 remains above the Medicare rate. Patients should be aware that balance billing is generally prohibited for in-network services under the No Surprises Act, but they must ensure their specific plan covers the service and that no out-of-network ancillary services trigger unexpected charges. To avoid errors, consumers should request a full itemized bill before paying, as summary invoices often obscure unbundled codes or services not rendered, and any disputes should be handled in writing to ensure proper resolution.