Colonoscopy with biopsy
Facility: Trego County Lemke Memorial Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,240
- Cash Discount Price: $886
- vs. Medicare Baseline: 1.01x 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 |
|---|---|---|
| Medicaid / KanCare | $166 - $2,000 | 14% |
| UnitedHealthcare | $166 - $2,000 | 14% |
| Va Ccn - All Plans | $166 - $1,240 | 14% |
| Aetna | $166 - $1,800 | 14% |
| Tricare | $166 - $1,058 | 14% |
| Ambetter / Centene | $174 - $1,364 | 14% |
| Healthy Blue Mcaid - All Plans | $391 - $2,000 | 32% |
| Humana | $980 | 80% |
| Blue Cross Blue Shield | $1,865 | 153% |
| Health Partners - All Plans | $1,900 | 155% |
Consumer Guidance & Cost Commentary
For the CPT code 45380, representing a colonoscopy with biopsy, Trego County Lemke Memorial Hospital in Wakeeney, KS, lists a gross charge of $1,043.00. While the facility's cash median rate is $886.00, commercial insurance negotiated rates vary significantly, ranging from $166 to $2,000 across ten different payers. Notably, the highest negotiated rate of $1,865.00 comes from Blue Cross Blue Shield, while Humana has a fixed rate of $980.00. It is important to note that cash payments can sometimes be more cost-effective than insurance claims, particularly for patients with high-deductible plans, as the cash price of $886.00 is lower than the median negotiated amount of $1,240.00. Patients should verify if the hospital offers self-pay or prompt-pay discounts, which can further reduce the final bill by avoiding administrative overhead associated with insurance billing cycles.
The facility's pricing structure is anchored by a Medicare amount of $1,222.56, which serves as a benchmark for fair pricing. Commercial negotiated rates often exceed this baseline due to the inclusion of administrative costs and contract dynamics, though the data indicates a wide spread in what different insurers are willing to pay. For instance, while Medicaid/KanCare and UnitedHealthcare have a low-end rate of $166.00, other payers like Health Partners and Aetna have fixed or high-end rates of $1,900.00 and $1,800.00 respectively.