Colonoscopy (diagnostic)
Facility: Susan B Allen Memorial Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $554
- Cash Discount Price: $1,070
- vs. Medicare Baseline: 0.58x 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 | $350 | 37% |
| Providrs Care | $757 | 80% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Susan B Allen Memorial Hospital in El Dorado, KS, the cash median price is $1,070, which is lower than the facility's gross charge of $1,646. While in-network insurance plans from UnitedHealthcare and Providrs Care have negotiated rates of $350 and $757 respectively, these amounts may not be the lowest possible option for every patient. If you have a high-deductible plan or have not yet met your deductible, paying the cash price directly could result in lower out-of-pocket costs compared to the insurance negotiated rates, as commercial contracts often include administrative markups that exceed the actual cost of care.
To ensure you are not overcharged, it is essential to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, since the facility is a voluntary non-profit, you should explicitly ask about self-pay or prompt-pay discounts, which can range from 20% to 50% off the billed amount if paid in full upfront. This bypasses the costly insurance claims processing cycle and eliminates the risk of balance billing, which is largely prohibited for non-emergency services at in-network facilities under the No Surprises Act. Always verify your specific plan's allowed amount and confirm that you are signing any waivers that could inadvertently waive your right to dispute out-of-network charges.