Colonoscopy with biopsy
Facility: Osborne County Memorial Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,678
- Cash Discount Price: $1,576
- vs. Medicare Baseline: 1.37x 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 | $1,409 | 115% |
| Health Partners Of Kansas | $1,594 | 130% |
| Wppa | $1,761 | 144% |
| Blue Cross Blue Shield | $1,817 | 149% |
Consumer Guidance & Cost Commentary
For the CPT code 45380, "Colonoscopy with biopsy," Osborne County Memorial Hospital in Osborne, KS, lists a cash price of $1,576.00, which is lower than the facility's gross charge of $1,854.00. While the hospital is a Critical Access Hospital with government-local ownership, the data does not provide specific county or state average rates for this procedure, so a direct comparison to regional averages cannot be made at this time. Patients with high-deductible plans or those who have already met their out-of-pocket maximum may find the cash price more favorable than the negotiated rates of $1,409.00 to $1,817.00 charged by in-network payers like UnitedHealthcare and Blue Cross Blue Shield, as the insurance allowed amounts are often higher than the cash rate.
To minimize costs, patients should verify if the hospital offers a "prompt-pay" discount for upfront payment, which can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees. It is also important to request an itemized billing audit before paying any invoice, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. If a patient receives a balance bill from an out-of-network provider at this facility, they may be entitled to protections under the No Surprises Act, which bans balance billing for emergency and non-emergency services at in-network facilities. Always confirm your plan's deductible status and ask for a self-pay classification prior to scheduling to ensure you are not inadvertently triggering higher insurance negotiated rates.