Colonoscopy (diagnostic)
Facility: Graham County Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $1,344
- Cash Discount Price: $1,725
- vs. Medicare Baseline: 1.41x 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 |
|---|---|---|
| Medicaid / KanCare | $474 | 50% |
| UnitedHealthcare | $474 - $1,639 | 50% |
| Medicare (plans) | $1,294 | 136% |
| Blue Cross Blue Shield | $1,308 | 138% |
| Celtic Commercial-All Other Plans | $1,423 | 150% |
| Wppa (Providers Care)-All Plans | $1,639 | 173% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Graham County Hospital in Hill City, Kansas, the cash price is $1,725, which matches the facility's median paid amount. While this cash rate is higher than the state average for this procedure, it is important to note that commercial insurance plans often pay significantly more than the cash price due to administrative costs and contract structures. For instance, UnitedHealthcare's negotiated rate ranges from $474 to $1,639, and Medicaid/KanCare pays a flat $474, both of which are lower than the cash price. However, patients with high-deductible plans or those who have not yet met their out-of-pocket maximums may find that paying the cash price directly is more cost-effective than relying on insurance, which could result in a higher allowed amount that the patient must cover.
The facility's negotiated rates vary widely among payers, with the median negotiated amount across all plans being $1,344, which is lower than the cash price. This suggests that while insurance contracts generally cap the charge below the gross list price, the specific allowed amount depends entirely on the individual plan. Patients should be aware that balance billing is largely prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but it is crucial to verify network status before scheduling. Additionally, since this is a Critical Access Hospital, patients should proactively ask about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the higher administrative fees associated with insurance billing cycles.