Colonoscopy (diagnostic)
Facility: Kansas Heart Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $1,347
- Cash Discount Price: $1,101
- vs. Medicare Baseline: 1.42x 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 |
|---|---|---|
| Wppa - All Plans | $539 - $859 | 57% |
| Tricare | $771 | 81% |
| Celtic Mcr Adv | $857 | 90% |
| Medicaid / KanCare | $857 - $2,148 | 90% |
| UnitedHealthcare | $857 - $2,148 | 90% |
| Humana | $857 | 90% |
| Blue Cross Blue Shield | $1,074 - $2,148 | 113% |
| Multiplan - All Plans | $1,213 - $1,934 | 128% |
| Aetna | $1,314 - $2,148 | 138% |
| Soonerselect Mcaid - All Plans | $1,347 - $2,148 | 142% |
| Celtic Mcaid - All Other Plans | $1,347 - $2,148 | 142% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Kansas Heart Hospital in Wichita, the negotiated rates for in-network payers range from $539 to $2,148, with a median negotiated amount of $1,347. This commercial rate is significantly higher than the Medicare benchmark of $950.10, reflecting the standard markup for commercial insurance contracts. While the facility offers a cash median price of $1,101, which is lower than the average negotiated rate, patients with high-deductible plans may find it beneficial to pay cash directly, as the insurance allowed amount often exceeds the cash price. To secure the lowest possible cost, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees.
It is important to note that the data provided represents specific negotiated rates for various payers and does not include state or county average comparisons, as those figures were not available in the source information. However, the facility's cash rate of $1,101 serves as a critical baseline for comparison against the commercial landscape. Patients should be aware that balance billing is generally prohibited for emergency services and non-emergency care at in-network facilities under the No Surprises Act, meaning unexpected bills for out-of-network providers at this hospital are likely illegal. If a patient receives a bill that appears to include balance billing or contains errors, they should request a formal itemized audit to identify unbundled codes or services not rendered, ensuring they only pay for the actual care received.