Colonoscopy with biopsy
Facility: Smith County Memorial Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,968
- Cash Discount Price: $2,094
- vs. Medicare Baseline: 1.61x 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 |
|---|---|---|
| Blue Cross Blue Shield | $1,350 | 110% |
| Medicaid / KanCare | $1,466 - $2,094 | 120% |
| Multiplan-All Plans | $1,884 | 154% |
| Wppa-All Plans | $1,968 | 161% |
| Midlands Choice-All Plans | $1,989 | 163% |
| UnitedHealthcare | $1,989 | 163% |
| Health Partners Of Ks Ppo-All Plans | $1,989 | 163% |
Consumer Guidance & Cost Commentary
For patients with high-deductible plans, paying cash upfront for this colonoscopy with biopsy procedure may be more cost-effective than using insurance, as the cash price of $2,094 is comparable to the negotiated rates paid by major payers like Medicaid/KanCare and UnitedHealthcare. While the facility's cash rate matches the median negotiated amount of $1,968, it is important to note that commercial insurance contracts often include administrative overhead that inflates the final bill. Patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as paying in full within 30 days can sometimes reduce the total cost by 20% to 50% by bypassing claims processing fees.
This service is provided at Smith County Memorial Hospital, a Critical Access Hospital in Smith Center, Kansas, where the Medicare benchmark rate of $1,222.56 serves as the objective baseline for fair pricing. The facility's cash rate represents a markup of 1.6 times the Medicare amount, which falls within the typical range for commercial pricing but suggests that the negotiated rates are not significantly lower than the cash option. Since the facility is government-owned locally, patients should verify their specific plan details and request an itemized bill to ensure no unexpected balance billing occurs, particularly if any ancillary services are out-of-network.