Colonoscopy with biopsy
Facility: Morris County Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,437
- Cash Discount Price: $1,589
- vs. Medicare Baseline: 1.18x 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 |
|---|---|---|
| Providrs Care (Wppa)(Nexus)-All Plans | $427 | 35% |
| UnitedHealthcare | $1,033 - $2,649 | 84% |
| Choice Care Mcr Adv-All Plans | $1,033 | 84% |
| Coventry Mcr | $1,033 | 84% |
| Va Ccn-All Plans | $1,033 | 84% |
| Blue Cross Blue Shield | $1,033 - $1,474 | 84% |
| Cigna | $1,916 | 157% |
| Aetna | $2,374 | 194% |
| Coventry Comm-All Other Plans | $2,384 | 195% |
| Multiplan-All Plans | $2,384 | 195% |
Consumer Guidance & Cost Commentary
For a colonoscopy with biopsy at Morris County Hospital in Council Grove, KS, the facility's cash median price of $1,589.00 is lower than the state average for this procedure. While the hospital's gross chargemaster lists the service at $2,649.00, patients with high-deductible plans may find paying cash directly more cost-effective than using insurance, as the facility's negotiated rates with major payers like UnitedHealthcare and Blue Cross Blue Shield range from $1,033 to $2,649.00, often exceeding the cash price. It is important to note that cash-pay options can sometimes result in lower out-of-pocket costs if the insurance negotiated rate is higher than the cash price, so patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are receiving the best possible rate.
The facility's Medicare benchmark of $1,222.56 serves as a critical baseline for evaluating pricing, as commercial rates are frequently marked up significantly above this federal standard. Although the hospital is a Critical Access Hospital with government-local ownership, the presence of balance billing risks remains if a patient receives care from out-of-network providers or ancillary services, even at an in-network facility. To protect against unexpected costs, patients should request a full itemized billing audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. If a balance bill arises, patients should not pay immediately but instead dispute the amount with their insurer and request a No Surprises Act audit to ensure compliance with federal protections.