Colonoscopy (diagnostic)
Facility: Mcpherson Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $977
- Cash Discount Price: $921
- vs. Medicare Baseline: 1.03x 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 |
|---|---|---|
| Tricare | $753 | 79% |
| Healthy Blue Mcr Adv | $855 | 90% |
| Blue Cross Blue Shield | $855 | 90% |
| Va Ccn - All Plans | $855 | 90% |
| Wellcare Mcr Adv - All Plans | $855 | 90% |
| Humana | $855 | 90% |
| UnitedHealthcare | $855 - $1,245 | 90% |
| Wppa - All Plans | $872 | 92% |
| Central Plains - All Plans | $934 | 98% |
| Medical Associates - All Plans | $934 | 98% |
| Ambetter / Centene | $984 | 104% |
| Christian Health Aid - All Plans | $996 | 105% |
| Aetna | $1,027 - $1,245 | 108% |
| Multiplan - All Plans | $1,120 | 118% |
| First Health - All Plans | $1,183 | 125% |
| Health Partners - All Plans | $1,183 | 125% |
| Cigna | $1,183 | 125% |
| Medicaid / KanCare | $1,245 | 131% |
| Health Blue Mcaid - All Other Plans | $1,270 | 134% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at McPherson Hospital in McPherson, Kansas, the facility's cash median rate of $921.00 is lower than the state average for this procedure. While commercial insurance carriers like UnitedHealthcare and Aetna negotiate rates ranging from $855 to $1,245, these amounts often exceed the cash price, making self-pay a potentially more affordable option for patients with high-deductible plans. It is important to note that commercial negotiated rates frequently include administrative overhead and do not reflect the true cost of care; comparing these rates to the Medicare benchmark of $950.10 reveals that the facility's cash rate is already below the federal baseline, suggesting that commercial contracts may be inflated relative to actual service costs.
Patients should proactively request a prompt-pay discount or self-pay rate before scheduling, as waiting until after receiving an insurance bill may result in higher charges. Although the facility offers a prompt-pay incentive, automatic claims submission by the hospital could void this discount if insurance coverage is active, so patients should consider signing a waiver of insurance submission to secure the lower cash price. Furthermore, if a balance bill arises from out-of-network ancillary services, patients should dispute the amount immediately rather than paying it out of fear of credit damage, as the No Surprises Act protects against such unexpected charges for emergency and non-emergency care at in-network facilities.