Colonoscopy with biopsy
Facility: Hospital District #6 Patterson Health Center
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $401
- Cash Discount Price: $500
- vs. Medicare Baseline: 0.33x 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 |
|---|---|---|
| UnitedHealthcare | $176 - $625 | 14% |
Consumer Guidance & Cost Commentary
For a colonoscopy with biopsy at the Hospital District #6 Patterson Health Center in Anthony, KS, the cash price is $500, which is lower than the facility's gross charge of $625. While the facility is a Critical Access Hospital owned by the government, the cash rate is notably lower than the Medicare benchmark of $1,222.56, suggesting a significant markup if commercial insurance is used. Patients with high-deductible plans may find paying the cash price of $500 more cost-effective than relying on insurance, as the negotiated rate for UnitedHealthcare plans is $401, yet the allowed amount could still result in substantial out-of-pocket costs if the deductible is not met. It is important to verify your specific plan's allowed amount before scheduling, as in-network rates vary by carrier and can sometimes exceed cash prices.
To avoid unexpected costs, patients should request a prompt-pay discount or self-pay rate before check-in, as these upfront payments often bypass the administrative overhead of insurance billing and can reduce the final bill. If you receive a bill after using insurance, it is crucial to demand a full itemized audit rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Under the No Surprises Act, you are protected from balance billing for out-of-network providers at in-network facilities, so any surprise charges should be disputed immediately with your insurer. Always confirm whether the facility has applied a prompt-pay discount to your account, as waiting until after the visit to ask for a cash discount may void the agreement if the hospital has already submitted a claim to your insurance.