Colonoscopy (diagnostic)
Facility: Nmc Health
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $841
- Cash Discount Price: $1,274
- vs. Medicare Baseline: 0.89x 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 |
|---|---|---|
| Bluestem Pace | $149 - $841 | 16% |
| Medicaid / KanCare | $238 - $1,345 | 25% |
| Leading Age | $238 - $1,345 | 25% |
| Wppa | $452 - $1,550 | 48% |
| Occunet | $493 - $1,691 | 52% |
| Samaritan Ministries International | $534 - $1,832 | 56% |
| Medincrease Health Plan | $534 - $1,832 | 56% |
| Prime Health Services | $617 - $2,114 | 65% |
| Aetna | $677 - $4,852 | 71% |
| UnitedHealthcare | $740 - $2,536 | 78% |
| Cigna | $781 - $2,677 | 82% |
| Blue Cross Blue Shield | $1,321 | 139% |
Consumer Guidance & Cost Commentary
For this diagnostic colonoscopy at Nmc Health in Newton, KS, the facility's cash price of $1,274 is lower than the gross charge of $2,231, but it remains higher than the state average for this procedure. While insurance plans like Aetna and UnitedHealthcare have negotiated rates ranging from $677 to $2,536, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. To secure the lowest possible rate, patients should explicitly ask the hospital for "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can significantly reduce the final bill compared to standard insurance processing.
It is important to distinguish between the facility's negotiated rates and the actual amount your insurance will pay, as commercial rates often include administrative overhead that pushes them well above the Medicare benchmark of $950.10. If you receive a bill that includes charges for services not rendered or unbundled components, you should request a full itemized audit rather than accepting a summary invoice. Under federal protections like the No Surprises Act, you are generally shielded from balance billing for out-of-network services at in-network facilities, so any unexpected charges should be disputed in writing with the billing supervisor rather than paid immediately.