Colonoscopy with biopsy
Facility: Regional Medical Center
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $870
- Cash Discount Price: $1,858
- vs. Medicare Baseline: 0.71x 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 |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 71% |
Consumer Guidance & Cost Commentary
Regional Medical Center in Manchester, Iowa, reports a cash median price of $1,858 for a Colonoscopy with biopsy (CPT code 45380). While the facility's gross charge is $2,322, the actual cash-pay rate is significantly lower, and the median negotiated rate with Medical Associates Health Plan - Tri is $870. It is important to note that for patients with high-deductible plans, paying the cash price of $1,858 upfront may be more cost-effective than using insurance, as the negotiated rate of $870 often exceeds the cash price when combined with deductible and copay costs.
The facility is a Critical Access Hospital with a government-local ownership structure and holds a 4-star rating. For this specific procedure, the cash rate of $1,858 is lower than the median paid amount of $2,761 reported in the data, though the negotiated rate of $870 represents the amount insurance carriers contractually agree to pay. Patients should verify their specific plan details, as commercial rates can vary based on network tiers and administrative structures. To maximize savings, individuals are encouraged to contact the hospital directly to inquire about self-pay or prompt-pay discounts before scheduling, ensuring they are aware of any potential fee reductions for upfront payment.