Colonoscopy (diagnostic)
Facility: Providence Medical Center
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $920
- Cash Discount Price: $876
- 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 |
|---|---|---|
| Medicaid / KanCare | $296 | 31% |
| UnitedHealthcare | $296 - $2,665 | 31% |
| Aetna | $300 - $2,488 | 32% |
| Healthy Blue | $302 - $920 | 32% |
| Celtic | $302 - $1,402 | 32% |
| Comp Alliance - Fka Compresults Worker Compensation | $622 | 65% |
| Midland Care Connection | $876 | 92% |
| Cigna | $876 | 92% |
| Medicare (plans) | $876 | 92% |
| Tricare | $876 | 92% |
| Kansas Superior Select | $920 | 97% |
| Corizon | $1,139 | 120% |
| Well Path Prison | $1,227 | 129% |
| Employer Direct Healthcare | $1,227 | 129% |
| Centurion | $1,314 | 138% |
| Naphcare | $1,358 | 143% |
| Oha Networks | $1,377 | 145% |
| Blue Cross Blue Shield | $1,402 - $1,621 | 148% |
| Worker Compensation | $1,420 | 149% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Providence Medical Center in Kansas City, KS, the cash median price is $876, which is significantly lower than the facility's negotiated rates for most major payers. While the facility's cash rate is competitive, commercial insurance plans often negotiate higher amounts due to administrative costs and contract structures; for instance, UnitedHealthcare and Aetna have negotiated ranges extending up to $2,665 and $2,488 respectively, far exceeding the cash price. Patients with high-deductible plans may find it financially advantageous to pay the cash rate of $876 upfront, as this avoids the substantial administrative markup inherent in insurance billing cycles. It is important to note that the facility is a voluntary non-profit church-owned hospital, and patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not being billed at the full negotiated rate.
The Medicare benchmark for this service is $950.10, which serves as a scientifically validated baseline for the true cost of care, distinct from the hospital's inflated chargemaster list. Commercial negotiated rates frequently exceed this benchmark, with some plans like Healthy Blue and Celtic ranging between $302 and $920, while others such as Blue Cross Blue Shield and Naphcare range from $1,358 to $1,621. Because Medicare rates represent the federal government's fixed reimbursement based on actual provider costs, comparing commercial rates to this figure rather than the hospital's gross charges provides a clearer picture of pricing fairness. To avoid unexpected costs, patients should request an itemized billing audit to verify that no unbundled codes or services not rendered are included in