Colonoscopy with biopsy
Facility: Sheridan County Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $2,030
- Cash Discount Price: $2,637
- vs. Medicare Baseline: 1.66x 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 Insurance | $1,595 | 130% |
| Blue Cross Blue Shield | $2,030 | 166% |
| UnitedHealthcare | $2,505 | 205% |
Consumer Guidance & Cost Commentary
For a "Colonoscopy with biopsy" at Sheridan County Hospital in Hoxie, KS, the cash price of $2,637 is significantly higher than the state average for this procedure. While the facility offers a negotiated rate of $2,030 to in-network insurers like Celtic Insurance, Blue Cross Blue Shield, and UnitedHealthcare, patients with high-deductible plans may find paying the full cash price upfront more cost-effective. This is because the cash rate ($2,637) is lower than the insurer's negotiated payment ($2,030) only if the patient's out-of-pocket costs exceed the difference, but in this specific case, the cash price is actually higher than the negotiated rate; however, paying cash avoids the administrative fees and potential balance billing associated with insurance claims. It is crucial to ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%, bypassing the costly insurance billing cycle entirely.
The facility's cash rate of $2,637 is also 1.7 times the Medicare benchmark amount of $1,222.56, indicating a substantial markup compared to the federal government's cost-based reimbursement. Since Medicare rates represent a scientifically validated baseline for the true cost of care, this ratio highlights that commercial rates often include significant administrative overhead and profit margins. To ensure you are not overcharged, request a full itemized bill that breaks down every CPT code and service rendered, as over 80% of hospital bills contain errors such as double-billing or unbundled charges. If you receive a surprise balance bill