Colonoscopy with biopsy
Facility: Hiawatha Community Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $266
- Cash Discount Price: $898
- vs. Medicare Baseline: 0.22x 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 |
|---|---|---|
| Ambetter / Centene | $164 | 13% |
| UnitedHealthcare | $166 - $206 | 14% |
| Aetna | $166 - $544 | 14% |
| Humana | $166 | 14% |
| Centrus Health Direct - All Plans | $199 | 16% |
| Multiplan - All Plans | $249 | 20% |
| Oscar - All Plans | $266 | 22% |
| Midlands Choice - All Plans | $460 | 38% |
| Wppa Providrs Care - All Plans | $529 | 43% |
| Preferred Hlth - All Plans | $567 | 46% |
| Cigna | $795 | 65% |
| Healthy Blue Mcaid - All Plans | $803 - $992 | 66% |
Consumer Guidance & Cost Commentary
For the CPT code 45380 (Colonoscopy with biopsy) at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $898.00, which matches the facility's cash median. This cash rate is significantly lower than the state average of $1,222.56, representing a 27% reduction compared to the Medicare benchmark. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should note that commercial negotiated rates vary widely among payers, ranging from $164 with Ambetter / Centene to $992 with Healthy Blue Mcaid - All Plans. Because these negotiated amounts often exceed the cash price, patients with high-deductible plans may find paying out-of-pocket at the cash rate of $898.00 to be the most cost-effective option, provided they have the funds available.
To ensure you are not overcharged, it is recommended to request a full itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, you should explicitly ask the facility about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront, bypassing the administrative costs associated with insurance claims processing. If you receive a balance bill from an out-of-network provider, remember that the No Surprises Act generally prohibits these charges for emergency care and non-emergency services at in-network facilities, and you should dispute any unexpected bills in writing rather than accepting summary invoices.