Colonoscopy with biopsy
Facility: Phillips County Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,506
- Cash Discount Price: $1,161
- vs. Medicare Baseline: 1.23x 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 | $391 - $1,883 | 32% |
| Medicaid / KanCare | $391 - $1,883 | 32% |
| Midlands Choice Profee Only-All Plans | $460 | 38% |
| Blue Cross Blue Shield | $1,474 - $1,525 | 121% |
| Health Partners-All Plans | $1,883 | 154% |
Consumer Guidance & Cost Commentary
For a colonoscopy with biopsy at Phillips County Hospital in Phillipsburg, KS, the cash median price is $1,161, which is lower than the facility's gross charge of $1,366. While the hospital is a Critical Access Hospital owned by the local government, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. For instance, UnitedHealthcare and Medicaid/KanCare have negotiated rates ranging from $391 to $1,883, with a median paid amount of $500, suggesting that for patients with high deductibles, paying the cash price directly might result in lower out-of-pocket costs compared to the insurance allowed amount. It is advisable to contact the hospital directly to confirm "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing the costly insurance claims cycle.
When reviewing your bill, it is crucial to request a full itemized statement rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. If you receive a balance bill from an out-of-network provider, even at an in-network facility, you may have protections under the No Surprises Act that prevent you from paying the difference between the provider's full charge and your insurance payment. Additionally, your commercial rates should be evaluated against the Medicare benchmark of $1,222.56; since fair pricing is typically defined as 120% to 150% of this rate, any commercial rate significantly higher than this range may indicate an opportunity to negotiate a more reasonable price before finalizing payment.