Colonoscopy with biopsy
Facility: Cloud County Health Center
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $582
- Cash Discount Price: $693
- vs. Medicare Baseline: 0.48x 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 |
|---|---|---|
| Mpi-All Plans | $224 | 18% |
| Pponext-All Plans | $940 | 77% |
Consumer Guidance & Cost Commentary
For a Colonoscopy with biopsy at Cloud County Health Center in Concordia, KS, the facility's cash price of $693.00 is lower than the median negotiated rate of $940.00 paid by Pponext-All Plans. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should note that cash payments can sometimes be more affordable than insurance claims, particularly if your plan has a high deductible or if the insurer's negotiated rate exceeds the cash price. The facility's cash rate is also notably lower than the Medicare benchmark of $1,222.56, which serves as a scientifically validated baseline for the true cost of care, suggesting the facility's pricing aligns with fair market value rather than inflated chargemaster lists.
To ensure you receive the most accurate pricing, it is advisable to ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling your visit, as these upfront incentives can further reduce costs by bypassing administrative claim processing fees. If you do proceed with insurance, be aware that the allowed amount for Mpi-All Plans is $224, which is significantly lower than the facility's cash rate, highlighting the variability in commercial payer contracts. Finally, if you receive a bill after care, always request a full itemized statement rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered that can be disputed to reduce your final balance.