Colonoscopy with biopsy
Facility: Children'S Mercy South
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $483
- Cash Discount Price: $463
- vs. Medicare Baseline: 0.40x 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 |
|---|---|---|
| Healthlink | $247 | 20% |
| Health Midwest Comprehensive Care | $265 | 22% |
| American Healthcare Alliance | $281 | 23% |
| Quiktrip | $347 | 28% |
| Wellfit/Centrus | $367 | 30% |
| Centivo | $378 | 31% |
| Nebraska Furniture Mart | $381 | 31% |
| UnitedHealthcare | $411 - $769 | 34% |
| Multiplan | $430 | 35% |
| Healthy Blue | $438 - $468 | 36% |
| Blue Cross Blue Shield | $441 - $760 | 36% |
| Medicaid / KanCare | $442 | 36% |
| Aetna | $443 - $506 | 36% |
| Home State Health | $468 | 38% |
| Humana | $478 | 39% |
| Orscheln | $483 | 40% |
| Wppa Providrs Care | $529 | 43% |
| Cigna | $535 | 44% |
| Coventry Health Care Of Kansas | $560 | 46% |
| Medica | $563 | 46% |
| Mercy Health | $704 | 58% |
| Coxhealth Network | $714 | 58% |
| National Preferred Provider Network | $849 | 69% |
Consumer Guidance & Cost Commentary
For the Colonoscopy with biopsy (CPT 45380) at Children's Mercy South in Overland Park, KS, the facility's cash median rate of $463.00 is significantly lower than the gross charge of $965.00 and the Medicare benchmark of $1,222.56. While the facility's negotiated rates with major payers like Blue Cross Blue Shield and UnitedHealthcare range from $430 to $769, these amounts often exceed the cash price, meaning patients with high-deductible plans may save money by paying out-of-pocket and seeking prompt-pay discounts. It is important to note that commercial rates are frequently inflated by administrative costs and contract structures, sometimes reaching 200% to 300% of the Medicare baseline, whereas fair pricing is typically defined as 120% to 150% of the Medicare rate.
Before scheduling, patients should verify their specific plan's allowed amount, as in-network rates vary widely among the 23 payers listed, with some charging up to $849 while others charge as low as $247. If you are self-paying, you should explicitly request a self-pay or prompt-pay discount prior to check-in to avoid automatic claims submission, which can void cash agreements and result in higher balances. Given that over 80% of hospital bills contain errors, consumers are encouraged to request a full itemized billing audit rather than accepting summary invoices, ensuring that all charges align with the actual services rendered and the negotiated or cash rates provided.