Colonoscopy with biopsy
Facility: Wamego Health Center
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $236
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.19x 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 | $225 | 18% |
| Medicaid / KanCare | $234 - $236 | 19% |
| Aetna | $234 | 19% |
| Providrs Care | $551 | 45% |
| Tricare | $691 | 57% |
| Blue Cross Blue Shield | $1,791 - $1,885 | 146% |
Consumer Guidance & Cost Commentary
For the CPT code 45380, representing a colonoscopy with biopsy, the facility's negotiated rates range from $225 to $691 depending on the payer. The lowest negotiated amount is $225 for UnitedHealthcare, while the highest is $691 for Tricare. These rates are significantly higher than the Medicare benchmark of $1,222.56, which serves as the federal baseline for this service. It is important to note that while commercial negotiated rates are often lower than the full chargemaster, they can still exceed the actual cost of care due to administrative overhead and contract structures. Patients should verify their specific plan's allowed amount before scheduling, as in-network status does not guarantee the lowest possible price, and some facilities may offer lower rates for self-pay patients who have not met their deductible.
To potentially reduce costs, patients should inquire about self-pay or prompt-pay discounts, which can range from 20% to 50% off the billed amount when paid in full upfront. These discounts bypass the administrative costs associated with insurance claims processing and provide immediate liquidity to the facility. Additionally, an itemized billing audit is recommended to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain inaccuracies that can be corrected. While the data provided does not include specific cash or state/county average comparisons for this procedure, understanding the difference between the negotiated rate and the actual cost of care is essential for making informed financial decisions.