Colonoscopy (diagnostic)
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $1,611
- Cash Discount Price: $2,993
- vs. Medicare Baseline: 1.70x 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 |
|---|---|---|
| Blue Cross Blue Shield | $165 - $2,315 | 17% |
| Indian Health Service Contracted [320198] | $165 | 17% |
| Provider Partners Health Plans Contracted [320450] | $182 | 19% |
| Medicaid / KanCare | $250 - $871 | 26% |
| UnitedHealthcare | $777 - $2,745 | 82% |
| Aetna | $826 - $1,484 | 87% |
| Halo Hcr Inc Hospice Contracted [320432] | $871 | 92% |
| Medical Associates Health Contracted [320444] | $871 | 92% |
| Cigna | $871 - $2,285 | 92% |
| Cross Timbers Hospice [20098] | $871 | 92% |
| Qual Choice Contracted [320325] | $871 | 92% |
| Kindful Hospice [20434] | $871 | 92% |
| Tricare | $871 | 92% |
| Mercy Hospice Okc [20252] | $871 | 92% |
| Halo Hcr Inc Hospice [20432] | $871 | 92% |
| Medicare (plans) | $871 | 92% |
| Kindful Hospice Contracted [320434] | $871 | 92% |
| Globalhealth Contracted [320145] | $871 | 92% |
| Cherokee Nation Health Serv Contracted [320066] | $871 | 92% |
| Pace Of The Ozarks Contracted [320518] | $871 | 92% |
| Elara Caring Aspire Hospice [20433] | $871 | 92% |
| Mercy Mgd Behavioral Health Contracted [320259] | $871 | 92% |
| Centivo Contracted [320505] | $888 | 93% |
| Humana | $888 | 93% |
| Dept Of Veteran Affairs Contracted [320106] | $888 | 93% |
| Mercy Benefit Admin Contracted [320251] | $952 - $2,078 | 100% |
| Show-Me Health Administrators Contracted [320483] | $952 - $1,781 | 100% |
| Medica Contracted [320239] | $1,080 | 114% |
| Point C Contracted [320238] | $1,484 - $2,226 | 156% |
| First Health Contracted [320128] | $1,484 | 156% |
| Health Choice Contracted [320166] | $1,550 | 163% |
| Insurance System Inc Contracted [320465] | $1,611 - $2,226 | 170% |
| Benefit Management Contracted [320052] | $1,611 - $2,226 | 170% |
| Healthscope Contracted [320182] | $1,611 - $2,226 | 170% |
| Health Systems Inc Contracted [320174] | $1,611 - $2,226 | 170% |
| United Medical Resources Contracted [320454] | $1,611 - $2,226 | 170% |
| Providrs Care Network Contracted [320484] | $1,686 - $1,781 | 177% |
| Imagine 360 Contracted [320494] | $2,078 | 219% |
| Auxiant Contracted [320462] | $2,078 - $2,226 | 219% |
| Ebms Contracted [320493] | $2,078 | 219% |
| Aither Health Contracted [320449] | $2,078 | 219% |
| Reflect Health Contracted [320492] | $2,078 | 219% |
| American Healthcare Alliance Contracted [320020] | $2,078 | 219% |
| Edison Health Solutions Contracted [320502] | $2,078 | 219% |
| Yuzu Health Contracted [320521] | $2,078 | 219% |
| Federal Medical Center Contracted [320127] | $2,226 | 234% |
| Preferred Health Plan Contracted [320522] | $2,226 | 234% |
| Healthlink Contracted [320179] | $2,226 | 234% |
| Compcare Of The Ozarks Contracted [320437] | $2,345 | 247% |
| Workers Comp [20426] | $2,374 | 250% |
| Private Health Care Systems Contracted [320320] | $2,745 | 289% |
| Multiplan Contracted [320270] | $2,820 | 297% |
| Multiplan [20270] | $2,820 | 297% |
Consumer Guidance & Cost Commentary
Mercy Specialty Hospital Southeast Kansas, located at 1619 K 66 in Galena, KS, reported a cash median price of $2,993 for a diagnostic colonoscopy. This cash rate is significantly lower than the facility's gross charge of $4,605 and the median negotiated rate of $1,611 paid by commercial payers. While the facility does not have a publicly available rating, the cash price of $2,993 is notably higher than the median paid rate of $655, illustrating how insurance administrative structures can inflate the baseline price by 20% to 40%. For patients with high-deductible plans where the insurance negotiated rate exceeds the cash price, paying out-of-pocket may result in lower immediate costs, though this should be weighed against potential out-of-pocket maximums.
The price transparency data indicates a wide variance in allowed amounts across different payers, with high-end rates reaching $2,820 and low-end rates as low as $165. The Medicare benchmark for this service is set at $950.10, which serves as the objective baseline to evaluate the facility's pricing markup. Commercial rates for this procedure average 200% to 300% of the Medicare rate, while fair pricing is typically defined as 120% to 150% of Medicare. Patients are advised to check with the hospital directly for "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% for upfront payment. Additionally, because over 80% of hospital bills contain errors, consumers should request a full item