Colonoscopy with biopsy
Facility: Great Plains Of Sabetha
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $551
- Cash Discount Price: $574
- vs. Medicare Baseline: 0.45x 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 |
|---|---|---|
| Celtic Mcr Adv | $166 - $1,076 | 14% |
| UnitedHealthcare | $168 - $2,070 | 14% |
| Aetna | $168 - $2,091 | 14% |
| Celtic Comm Exchange-All Other Plans | $208 - $1,346 | 17% |
| Medicaid / KanCare | $225 - $2,070 | 18% |
| Great West Healthcare-All Plans | $473 - $1,760 | 39% |
| Century/Wppa/Providers-All Plans | $501 - $1,966 | 41% |
| Multiplan-Phcs-All Plans | $529 - $1,966 | 43% |
| Federated Mutual Ins-All Plans | $535 - $1,987 | 44% |
| Humana | $545 - $1,966 | 45% |
| Cigna | $545 - $1,966 | 45% |
| Blue Cross Blue Shield | $574 - $2,070 | 47% |
Consumer Guidance & Cost Commentary
For the CPT code 45380, representing a colonoscopy with biopsy, Great Plains of Sabetha in Sabetha, KS, lists a cash price of $574.00, which matches the facility's cash median. This cash rate is significantly lower than the Medicare benchmark of $1,222.56, aligning with the principle that commercial negotiated rates often exceed fair pricing standards. While the facility's cash price is lower than the state average for this procedure, patients should be aware that insurance negotiated rates can sometimes be higher than the cash price. For instance, UnitedHealthcare and Aetna have negotiated ranges extending up to $2,091, meaning a patient with a high deductible might save money by paying the cash price directly, provided they obtain a "waiver of insurance submission" to avoid automatic claims processing.
The facility's median negotiated rate of $551.00 is slightly higher than its cash price, illustrating that administrative overhead and contract dynamics often inflate commercial rates. Patients should request an itemized billing audit before finalizing payment, as summary bills can obscure unbundled charges or services not rendered, which are common sources of medical debt. Additionally, inquiring about prompt-pay discounts, which can reduce bills by 20% to 50%, is recommended before scheduling, as these discounts are typically only available if requested upfront rather than after receiving a post-insurance bill. Given the facility's status as a Critical Access Hospital with a voluntary non-profit ownership, verifying the specific allowed amount for your plan is essential to ensure you are not subject to balance billing, especially if you have out-of-network ancillary services.