Colonoscopy (diagnostic)
Facility: Holton Community Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $232
- Cash Discount Price: $603
- vs. Medicare Baseline: 0.24x 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 |
|---|---|---|
| UnitedHealthcare | $154 - $307 | 16% |
| Aetna | $154 - $724 | 16% |
| Humana | $155 | 16% |
| Kansas Superior Select - All Plans | $157 | 17% |
| Medicaid / KanCare | $307 | 32% |
Consumer Guidance & Cost Commentary
For this diagnostic colonoscopy at Holton Community Hospital in Holton, KS, the facility's cash median price is $603.00, which is lower than the state average for this procedure. While commercial insurance plans like UnitedHealthcare and Aetna have negotiated rates ranging from $154 to $724, these amounts often exceed the cash price, making self-pay a potentially more affordable option for patients with high-deductible plans. The facility, a voluntary non-profit Critical Access Hospital, offers a median negotiated rate of $232.00, but patients should verify their specific plan's allowed amount before scheduling to ensure they are not paying more than necessary.
To avoid unexpected costs, patients should proactively request a "self-pay" or "prompt-pay" discount at registration, which can significantly reduce the final bill. It is also important to request a full itemized CPT-coded bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. If a balance bill arises from an out-of-network provider, patients should not pay immediately; instead, they should dispute the charge with their insurer and request a No Surprises Act audit to protect against surprise billing.