Colonoscopy (diagnostic)
Facility: Pratt Regional Medical Center
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $920
- Cash Discount Price: $819
- vs. Medicare Baseline: 0.97x 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 |
|---|---|---|
| Christian Health Aid | $135 - $1,373 | 14% |
| UnitedHealthcare | $150 - $1,868 | 16% |
| Health Partners Of Kansas | $153 - $1,556 | 16% |
| Aetna | $162 - $1,648 | 17% |
| Choicecare | $180 - $1,831 | 19% |
| Celtic Insurance Company | $847 | 89% |
| Healthy Blue | $872 | 92% |
Consumer Guidance & Cost Commentary
For this diagnostic colonoscopy at Pratt Regional Medical Center in Pratt, Kansas, the facility's cash price of $819.00 is notably lower than the state average for this procedure. While the Medicare benchmark of $950.10 serves as a reliable baseline for fair pricing, commercial insurance negotiated rates vary significantly by plan. For instance, Celtic Insurance Company and Healthy Blue have fixed negotiated rates of $847 and $872 respectively, which are only slightly higher than the cash price. In contrast, other payers like UnitedHealthcare and Choicecare have negotiated ranges extending up to $1,868 and $1,831, demonstrating that in-network coverage does not guarantee the lowest possible cost. Patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the $819.00 rate avoids the administrative markups inherent in insurance billing structures.
To secure the best possible rate, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling their appointment, as these upfront payment incentives can reduce the final bill by 20% to 50%. It is crucial to verify your specific plan's allowed amount prior to treatment, as assuming that in-network status equals the lowest price can lead to unexpected costs if your carrier negotiates a higher rate than the cash price. Additionally, if you choose to use insurance, ensure you understand your deductible status, as paying the negotiated rate before meeting your deductible may result in out-of-pocket expenses exceeding the cash option. Finally, always request a detailed, itemized bill after your visit to review every CPT code and charge, ensuring that no services were unbundled or