Colonoscopy with biopsy
Facility: Wilson Medical Center
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,801
- Cash Discount Price: $1,688
- vs. Medicare Baseline: 1.47x 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 |
|---|---|---|
| Aetna | $1,193 - $2,251 | 98% |
| Ambetter / Centene | $1,193 - $2,251 | 98% |
| Tricare | $1,193 | 98% |
| UnitedHealthcare | $1,193 - $2,093 | 98% |
| Humana | $1,193 | 98% |
| Blue Cross Blue Shield | $1,350 - $2,251 | 110% |
| Cigna | $1,801 | 147% |
| Health Partners-All Plans | $2,071 | 169% |
| Mulitplan-All Plans | $2,071 | 169% |
Consumer Guidance & Cost Commentary
For the CPT code 45380 (Colonoscopy with biopsy) at Wilson Medical Center in Neodesha, KS, the facility's cash median price is $1,688, which is notably higher than the state average of $1,312. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find the cash price more affordable than their insurance negotiated rates, which range from $1,193 to $2,251 depending on the payer. It is important to note that commercial negotiated rates often include administrative overhead and contract premiums, meaning the cash price can sometimes represent a better value for self-pay patients. Additionally, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, effectively bypassing the costly insurance claims processing cycle.
When reviewing your final invoice, be aware that hospitals may initially issue summary bills that obscure individual charges, so it is crucial to request a full itemized CPT-coded statement before agreeing to any payment plan. This audit helps identify potential errors, such as code unbundling or services not rendered, which occur in over 80% of hospital bills. Furthermore, while the facility's gross charge is $2,251, the Medicare benchmark for this service is $1,222.56, providing a scientifically validated baseline to evaluate the facility's pricing markup. If you receive a balance bill for the difference between the provider's charge and your insurance allowed amount, you may have protections under the No Surprises Act, particularly if the