Colonoscopy (diagnostic)
Facility: Saint Luke'S South Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $2,266
- Cash Discount Price: $5,974
- vs. Medicare Baseline: 2.39x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 239% of the Medicare baseline (a markup of 139%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 - $777 | 31% |
| Humana | $1,350 - $3,029 | 142% |
| Cigna | $1,350 - $6,179 | 142% |
| UnitedHealthcare | $1,393 - $2,326 | 147% |
| Commercial-Contracted [8000] | $1,811 | 191% |
| Blue Cross Blue Shield | $2,814 - $3,309 | 296% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Saint Luke's South Hospital in Overland Park, KS, the facility's cash median price of $5,974 is significantly higher than the state average for this procedure. While the hospital's negotiated rates for commercial payers like Humana and Cigna range from $1,350 to $6,179, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying cash upfront rather than relying on insurance. It is crucial to verify the specific "self-pay" or "prompt-pay" discount available before scheduling, as hospitals frequently offer fee reductions of 20% to 50% for upfront payment that bypasses the administrative costs and claim processing fees embedded in commercial negotiated rates.
When comparing this facility's pricing to federal benchmarks, the Medicare amount of $950.1 serves as the objective baseline for evaluating true costs. The facility's cash median of $5,974 represents a markup of 2.4 times the Medicare rate, which is substantially higher than the typical fair pricing range of 120% to 150% of Medicare. Patients should avoid assuming that being in-network guarantees the lowest possible price, as some in-network hospitals charge significantly more than others for the same service. To ensure transparency and avoid unexpected balance billing, consumers should request a full itemized CPT-coded bill before paying, as summary bills often obscure individual charges and errors.