Colonoscopy with biopsy
Facility: Fredonia Regional Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,056
- Cash Discount Price: $1,485
- vs. Medicare Baseline: 0.86x 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 |
|---|---|---|
| Veterans Programs - All Plans | $152 - $1,056 | 12% |
| Blue Cross Blue Shield | $152 - $1,364 | 12% |
| Aetna | $459 - $1,863 | 38% |
| Meritain-All Plans | $810 - $1,863 | 66% |
| UnitedHealthcare | $810 - $1,863 | 66% |
| Cigna | $810 - $1,863 | 66% |
| Reserve National-All Plans | $810 - $1,863 | 66% |
Consumer Guidance & Cost Commentary
For the CPT code 45380 (Colonoscopy with biopsy) at Fredonia Regional Hospital in Kansas, the cash price is $1,485.00, which matches the facility's median paid amount. While the hospital is a Critical Access Hospital owned by the local government, the negotiated rates vary significantly by insurer, ranging from a low of $152 to a high of $1,863. It is important to note that for patients with high-deductible plans, paying the cash price of $1,485.00 upfront can sometimes be more cost-effective than relying on insurance, as the negotiated rates for many payers exceed this amount. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can lower the total cost further.
When evaluating the cost, it is more accurate to compare rates against the Medicare benchmark of $1,222.56 rather than the hospital's gross chargemaster list. The cash price of $1,485.00 is slightly higher than the Medicare rate (a ratio of 0.9), indicating a modest markup above the federal baseline. If you receive a bill from an out-of-network provider, you may be subject to balance billing, where the provider charges the difference between their full rate and what your insurance pays. To avoid this, ensure you have a signed waiver of insurance submission if paying cash, and always request a detailed, itemized bill to verify that no unbundled codes or services not rendered are included.