Colonoscopy (diagnostic)
Facility: Nemaha Valley Community Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $415
- Cash Discount Price: $911
- vs. Medicare Baseline: 0.44x 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 |
|---|---|---|
| Va Ccn - All Plans | $154 | 16% |
| Humana | $154 - $462 | 16% |
| Aetna | $155 - $892 | 16% |
| Celtic Comm Exch - All Plans | $161 - $329 | 17% |
| Partners Direct Health - All Plans | $169 - $546 | 18% |
| Blue Cross Blue Shield | $408 | 43% |
| Midlands Choice - All Plans | $423 - $998 | 45% |
| Multiplan - All Plans | $585 - $945 | 62% |
| Health Partners - All Plans | $662 - $998 | 70% |
Consumer Guidance & Cost Commentary
For the diagnostic colonoscopy procedure at Nemaha Valley Community Hospital in Seneca, KS, the facility's cash median price of $911 is lower than the state average for this service. While commercial insurance plans like Aetna and Midlands Choice have negotiated rates ranging from $155 to $998, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, unexpected ancillary services or emergency care could still trigger surprise bills if not carefully reviewed. Consumers should verify their specific plan's allowed amount before scheduling, as some insurers may allow amounts that are significantly higher than the facility's cash rate.
To ensure you are not overcharged, request a full itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. If you choose to pay directly, ask the hospital about prompt-pay discounts, which can reduce the bill by 20% to 50% for upfront payment and bypass costly insurance processing fees. The facility's negotiated rate of $415 represents a significant discount from the gross charge of $1,013, but this is still higher than the cash price; therefore, the most cost-effective option for many patients is to pay the cash median of $911 or seek a prompt-pay reduction rather than relying on insurance coverage that may result in higher net costs.