Colonoscopy (diagnostic)
Facility: Hamilton County Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $366
- Cash Discount Price: $265
- vs. Medicare Baseline: 0.39x 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 |
|---|---|---|
| First Health Coventry - All Plans | $225 | 24% |
| Cigna | $251 | 26% |
| UnitedHealthcare | $251 | 26% |
| Aetna | $366 | 39% |
| Blue Cross Blue Shield | $621 - $1,321 | 65% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Hamilton County Hospital in Syracuse, KS, the cash price is $265, which is significantly lower than the facility's negotiated rates with major insurers like Aetna ($366) and Blue Cross Blue Shield ($621 to $1,321). While Medicare sets the benchmark at $950.10, commercial contracts often exceed this baseline due to administrative costs and contract dynamics. Patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate is higher than $265, as paying out-of-pocket avoids the full deductible and potential balance billing. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan details and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can further reduce the final cost.
The facility's pricing structure reflects standard commercial billing practices where negotiated rates serve as a ceiling to protect in-network members, yet these rates frequently remain above cash prices. With a median negotiated payment of $251 across five payers, the data suggests that while insurance coverage provides a predictable maximum, the actual amount paid varies by carrier and plan. To ensure you are not overpaying, it is recommended to request an itemized billing audit if you receive a summary bill, as over 80% of hospital invoices contain errors such as unbundled codes or charges for services not rendered. Always dispute any unexpected balances in writing rather than accepting summary totals, and remember that commercial rates are often marked up significantly compared to the true cost represented by Medicare benchmarks.