Colonoscopy (diagnostic)
Facility: Ellinwood District Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $798
- Cash Discount Price: $969
- vs. Medicare Baseline: 0.84x 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 |
|---|---|---|
| Cigna | $420 - $1,177 | 44% |
| UnitedHealthcare | $420 - $1,177 | 44% |
| Humana | $420 - $1,177 | 44% |
| Blue Cross Blue Shield | $420 - $1,177 | 44% |
| Aetna | $420 - $1,177 | 44% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Ellinwood District Hospital, the cash median price is $969.00, which is notably lower than the negotiated rates of $798.00 paid by major insurers like Cigna, UnitedHealthcare, and Humana. While commercial payers have a range of $420 to $1177 depending on their specific plan, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance allowed amount exceeds this figure. Because the facility is a Critical Access Hospital in Ellinwood, KS, and operates under government ownership, it is recommended to explicitly ask for "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can significantly lower the final bill compared to standard insurance processing.
The Medicare benchmark for this procedure is $950.10, which serves as a reliable baseline for evaluating the facility's pricing structure rather than the inflated chargemaster list price. Although the data does not provide specific state or county average comparisons for this code, the facility's government ownership and Critical Access status often influence how rates are set relative to regional cost reports. To ensure you are not overcharged, always request a full itemized CPT-coded bill before paying, as summary bills can obscure unbundled charges or services not rendered. If you receive a balance bill from an out-of-network provider at this in-network facility, you may be entitled to protections under the No Surprises Act, and you should dispute any unexpected charges in writing rather than accepting them immediately.