Colonoscopy with biopsy
Facility: Clay County Medical Center
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $842
- Cash Discount Price: $905
- vs. Medicare Baseline: 0.69x 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 |
|---|---|---|
| Multiplan- All Plans | $184 - $860 | 15% |
| UnitedHealthcare | $512 - $860 | 42% |
| Health Partners - All Plans | $795 - $860 | 65% |
| Wppa/Providrs Care- All Plans | $842 | 69% |
| Aetna | $842 | 69% |
Consumer Guidance & Cost Commentary
For the CPT code 45380, representing a colonoscopy with biopsy, Clay County Medical Center in Clay Center, KS, lists a cash median price of $905.00, which matches the facility's gross charge. This cash rate is notably lower than the state average for this procedure, as the median paid amount across all payers is $842.00, while the Medicare benchmark is $1,222.56. The facility, a Critical Access Hospital with government-local ownership, reports a facility rating of 3. Patients with high-deductible plans may find the cash price advantageous if their insurance negotiated rates exceed this amount, though the data indicates the median negotiated rate is also $842.00.
To maximize savings, patients should inquire about prompt-pay discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. It is crucial to request a self-pay classification and sign a waiver of insurance submission to avoid automatic claims processing that might void cash agreements. Additionally, while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, patients should always request a detailed, itemized bill to verify that no unbundled codes or services not rendered have inflated the total charge.