Colonoscopy with biopsy
Facility: Girard Medical Center
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $166
- Cash Discount Price: $734
- vs. Medicare Baseline: 0.14x 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 |
|---|---|---|
| Humana | $166 | 14% |
| Kansas Superior Select-All Plans | $166 | 14% |
| UnitedHealthcare | $166 - $284 | 14% |
| Ambetter / Centene | $166 | 14% |
| Aetna | $166 | 14% |
| Medicare (plans) | $166 | 14% |
| Blue Cross Blue Shield | $166 | 14% |
| Uhhis-All Plans | $284 | 23% |
| Multiplan-All Plans | $1,132 | 93% |
Consumer Guidance & Cost Commentary
For this Colonoscopy with biopsy at Girard Medical Center in Girard, KS, the facility's cash median price of $734.00 is significantly lower than the state average of $1,132.00, which aligns closely with the Medicare benchmark of $1,222.56. While the gross charge listed is $1,224.00, patients should be aware that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures. In this case, the median negotiated rate across payers is $166.00, but this figure represents the amount insurers agree to pay, not necessarily what a patient owes. If you have a high-deductible plan, paying the cash price of $734.00 upfront might be more cost-effective than relying on insurance, especially if your deductible has not yet been met or if the insurer's allowed amount is lower than the cash rate.
To minimize costs, it is essential to verify the specific "self-pay" or "prompt-pay" discounts offered by the hospital before scheduling, as these can further reduce the final bill. Although the data indicates a median negotiated rate of $166.00, this does not guarantee the lowest possible out-of-pocket cost for every individual plan, as some commercial payers may have different contract terms. Additionally, while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, it is prudent to request a detailed, itemized bill to ensure no unbundled codes or services not rendered are included. Given that over 80% of hospital bills contain errors, reviewing the line-by-line charges is a