Colonoscopy with biopsy
Facility: Bob Wilson Memorial Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,820
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.49x 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 | $1,820 | 149% |
Consumer Guidance & Cost Commentary
For a colonoscopy with biopsy at Bob Wilson Memorial Hospital in Ulysses, Kansas, the facility's negotiated rate is $1,820.00, which is exactly 1.5 times the Medicare benchmark of $1,222.56. This facility is a Critical Access Hospital owned by a voluntary non-profit church, and while Blue Cross Blue Shield is the only payer with a contract, the negotiated rate aligns precisely with their low and high bounds. Because the negotiated rate exceeds the Medicare amount, patients with high-deductible plans might find that paying cash directly could be more cost-effective, provided they secure a "self-pay" or "prompt-pay" discount before scheduling. It is important to note that commercial negotiated rates often include administrative overhead and do not represent the true cost of care, which is better reflected by the Medicare benchmark.
Patients should be aware that hospitals often issue summary bills that obscure individual charges, making it difficult to identify errors or unbundled services. If you receive a bill for this procedure, request a full itemized audit to verify that no services were double-billed or charged for items that were never rendered. Additionally, if you are out-of-network, the No Surprises Act may protect you from balance billing for emergency care or non-emergency services at in-network facilities, but you should still dispute any unexpected charges in writing rather than accepting them immediately. Always confirm your deductible status and ask the hospital to classify your account as self-pay to ensure you are eligible for any prompt-pay discounts that could significantly reduce your out-of-pocket costs.