Colonoscopy with biopsy
Facility: Community Memorial Healthcare, Inc.
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $585
- Cash Discount Price: $1,154
- 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 |
|---|---|---|
| Aetna | $166 - $1,208 | 14% |
| UnitedHealthcare | $183 - $864 | 15% |
| Blue Cross Blue Shield | $476 - $1,364 | 39% |
Consumer Guidance & Cost Commentary
For the CPT code 45380, representing a colonoscopy with biopsy, Community Memorial Healthcare, Inc. in Marysville, KS, lists a cash median price of $1,154.00, which matches the facility's gross charge. This cash rate is significantly higher than the state average of $585.00, though it remains below the national average for this procedure. While commercial payers like Aetna, UnitedHealthcare, and Blue Cross Blue Shield have negotiated rates ranging from $166 to $1,364, these amounts often exceed the cash price for patients with high-deductible plans. In such cases, paying the cash median of $1,154.00 directly can be more cost-effective than relying on insurance, provided the patient's deductible has been met or the negotiated rate exceeds the cash amount.
Patients should proactively contact the hospital to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% when paid in full upfront. It is important to verify that the facility is correctly classified as self-pay before scheduling to avoid automatic claims submission that could void these discounts. Additionally, while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still request an itemized billing audit to ensure no unbundled codes or services not rendered are included in the final statement. Always confirm your specific deductible status and the exact allowed amount with the billing department before proceeding with treatment.