Colonoscopy with biopsy
Facility: William Newton Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $166
- Cash Discount Price: $976
- 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 |
|---|---|---|
| Triwest- All Plans | $158 | 13% |
| Blue Cross Blue Shield | $166 | 14% |
| UnitedHealthcare | $166 | 14% |
| Ambetter / Centene | $191 - $225 | 16% |
Consumer Guidance & Cost Commentary
For the CPT code 45380, representing a colonoscopy with biopsy at William Newton Hospital in Winfield, KS, the cash price is $976.00, which matches the facility's median paid amount. This cash rate is significantly lower than the Medicare benchmark of $1,222.56, indicating a markup of only 0.1% above the federal baseline. While the hospital is a Critical Access Hospital with a government-local ownership structure, patients should be aware that commercial insurance negotiated rates vary widely; for instance, Ambetter/Centene plans have a range of $191 to $225, whereas Blue Cross Blue Shield and UnitedHealthcare have fixed negotiated rates of $166. Because these negotiated amounts are often inflated by administrative processing costs, paying cash upfront can sometimes result in substantial savings compared to what an insurance plan would allow.
To maximize potential savings, patients should inquire about prompt-pay discounts, which typically offer a fee reduction of 20% to 50% for upfront payments, effectively bypassing the costly insurance claims cycle. It is crucial to request self-pay classification and a waiver of insurance submission before check-in to ensure the hospital applies these cash rates rather than submitting a claim that could void the discount. Additionally, since over 80% of hospital bills contain errors, patients should always demand a full itemized CPT-coded statement before finalizing payment to identify any unbundled codes or services not rendered. While the facility is located in Winfield (ZIP 67156), the provided data does not include specific county or state average comparisons for this procedure, so the focus remains on comparing the facility's cash rate