Colonoscopy with biopsy
Facility: Amberwell Atchison Association
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $261
- Cash Discount Price: $898
- vs. Medicare Baseline: 0.21x 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 |
|---|---|---|
| UnitedHealthcare | $166 - $391 | 14% |
| Triwest - All Plans | $166 | 14% |
| Va Ccn - All Plans | $166 | 14% |
| Superior Select Mcr Adv - All Plans | $166 | 14% |
| Humana | $166 - $223 | 14% |
| Centrus Health Direct - All Plans | $199 | 16% |
| Cigna | $221 | 18% |
| Ambetter / Centene | $261 | 21% |
| Oscar - All Plans | $266 | 22% |
| Multiplan - All Plans | $316 | 26% |
| Aetna | $520 | 43% |
| Wppa Providrs Care - All Plans | $568 | 46% |
| Blue Cross Blue Shield | $728 | 60% |
Consumer Guidance & Cost Commentary
For the procedure "Colonoscopy with biopsy" at Amberwell Atchison Association in Atchison, KS, the cash price is $898.00, which matches the facility's cash median. This rate is significantly lower than the Medicare benchmark of $1,222.56, indicating a markup of 0.2 above the federal baseline. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that their insurance negotiated rates vary widely; for instance, UnitedHealthcare and Triwest - All Plans have a low-end negotiated rate of $166, whereas Blue Cross Blue Shield's rate is $728. If you have a high-deductible plan where your out-of-pocket costs exceed $898.00, paying the cash price directly may result in immediate savings compared to the insurance negotiated rates.
To maximize potential savings, you should contact the hospital before scheduling to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront. These discounts bypass the administrative costs associated with insurance claims processing and provide immediate liquidity to the facility. Additionally, if you are using insurance, be cautious of balance billing scenarios where out-of-network providers might bill you for the difference between their chargemaster and the insurance allowed amount, though the No Surprises Act offers protections for emergency care and non-emergency services at in-network facilities. Always request an itemized bill to verify that no unbundled codes or services not rendered are included before finalizing payment.