Colonoscopy with biopsy
Facility: Scott County Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,510
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.24x 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 | $382 - $2,391 | 31% |
| Humana | $1,057 | 86% |
| Wppa | $1,200 - $1,510 | 98% |
| Blue Cross Blue Shield | $1,364 | 112% |
| Aetna | $2,265 | 185% |
Consumer Guidance & Cost Commentary
For a colonoscopy with biopsy at Scott County Hospital in Scott City, KS, the negotiated payment rates for in-network insurance plans range from $1,057 to $2,391, with a median negotiated amount of $1,510. This commercial rate is 20% higher than the Medicare benchmark of $1,222.56, which serves as the objective baseline for fair pricing. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that cash-pay options are not listed in the current data. However, for individuals with high-deductible plans, paying cash upfront can sometimes be more cost-effective if the insurance negotiated rate exceeds the facility's cash price, though specific cash rates must be confirmed directly with the hospital.
To maximize savings, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling their appointment, as these upfront payment incentives can significantly reduce the final bill by bypassing costly insurance claims processing. It is also important to avoid accepting summary bills that obscure individual charges; instead, patients should demand a full itemized statement to identify any unbundled codes or services not rendered. Finally, while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should verify their deductible status and ensure they are not inadvertently signing away rights to dispute out-of-network ancillary services during registration.