Colonoscopy (diagnostic)
Facility: Saint John Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $894
- Cash Discount Price: $876
- vs. Medicare Baseline: 0.94x 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 $950.1 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 | $296 - $1,227 | 31% |
| Medicaid / KanCare | $296 | 31% |
| Celtic | $302 - $1,402 | 32% |
| Healthy Blue | $302 - $920 | 32% |
| Comp Alliance Workers Comp | $622 | 65% |
| Blue Cross Blue Shield | $661 - $1,321 | 70% |
| Medicare (plans) | $876 | 92% |
| Aetna | $876 - $2,488 | 92% |
| Midland Care Connection | $876 | 92% |
| Tricare | $876 | 92% |
| Cigna | $876 | 92% |
| Kansas Superior Select | $894 | 94% |
| Well Path | $1,227 | 129% |
| Employer Direct Healthcare | $1,227 | 129% |
| Corizon | $1,227 | 129% |
| Centurion | $1,314 | 138% |
| Naphcare | $1,358 | 143% |
| Oha Networks | $1,377 | 145% |
| Worker Compensation | $1,420 | 149% |
Consumer Guidance & Cost Commentary
For the diagnostic colonoscopy procedure at Saint John Hospital in Leavenworth, KS, the cash price of $876.00 is significantly lower than the facility's gross charge of $4,695.00. While the facility's negotiated rates for commercial payers range from $296 to $2,488, the cash price remains the lowest option for patients without insurance. It is important to note that for individuals with high-deductible plans, paying the cash price of $876.00 upfront can be more cost-effective than using insurance, as the negotiated rates often exceed this amount. Patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these incentives can further reduce the final bill by bypassing administrative fees and claims processing costs.
When evaluating the facility's pricing against state and national standards, the Medicare benchmark of $950.10 serves as the most reliable baseline for understanding true costs. The facility's cash rate of $876.00 is slightly below the Medicare amount, whereas the median negotiated rate of $894.00 is marginally higher. This comparison highlights that commercial rates are not always the lowest available; in this case, the cash price is already competitive with the federal government's cost-based reimbursement. To ensure you are receiving fair pricing, we recommend requesting a detailed, itemized bill to verify that all charges align with the CPT code 45378 and that no unbundled services or errors have inflated the total.