Colonoscopy with biopsy
Facility: Memorial Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $174
- Cash Discount Price: $989
- 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 |
|---|---|---|
| Tricare | $166 | 14% |
| Ambetter / Centene | $183 | 15% |
Consumer Guidance & Cost Commentary
For a Colonoscopy with biopsy at Memorial Hospital in Abilene, KS, the cash price is $989.00, which matches the facility's median negotiated rate for Tricare and Ambetter / Centene plans. While commercial insurance contracts often result in higher allowed amounts due to administrative overhead, paying cash directly can sometimes be more cost-effective for patients with high-deductible plans if the insurer's negotiated rate exceeds the cash price. It is important to note that the facility's cash rate is significantly lower than the Medicare benchmark of $1,222.56, suggesting that the commercial rates offered here are already discounted relative to the federal government's cost-based standard.
Patients should verify whether their specific insurance plan has a deductible that must be met before coverage applies, as this could lead to unexpected out-of-pocket costs even with in-network billing. If you choose to pay out-of-pocket, ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the total bill by 20% to 50% if settled upfront. Additionally, if you receive a bill from an out-of-network provider at this facility, you may be protected by the No Surprises Act, which bans balance billing for emergency and non-emergency services; in such cases, you should dispute the bill in writing rather than paying immediately to avoid surprise charges.