Colonoscopy (diagnostic)
Facility: Ellsworth County Medical Center
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $1,501
- Cash Discount Price: $1,668
- vs. Medicare Baseline: 1.58x 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 |
|---|---|---|
| Triwest -All Plans | $784 | 83% |
| Healthy Blue Mcr Adv | $784 | 83% |
| Va Ccn-All Plans | $784 | 83% |
| Humana | $784 - $1,584 | 83% |
| UnitedHealthcare | $1,084 - $1,668 | 114% |
| Blue Cross Blue Shield | $1,243 - $1,308 | 131% |
| Aetna | $1,501 | 158% |
| First Health - All Plans | $1,501 | 158% |
| Cigna | $1,584 | 167% |
| Medicaid / KanCare | $1,668 | 176% |
| Healthy Blue Mcaid- All Other Plans | $1,668 | 176% |
| Coventry Mcaid-All Plans | $1,668 | 176% |
| Providers Care-Wppa-All Plans | $2,502 | 263% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Ellsworth County Medical Center, the cash price is $1,668, which matches the facility's negotiated rate of $1,501 and the cash median of $1,668. This cash price is significantly higher than the Medicare benchmark of $950.10, reflecting a markup of 1.6 times the federal baseline. While commercial insurance plans like Humana and UnitedHealthcare have negotiated rates ranging from $1,084 to $1,668 depending on the specific plan, these amounts often exceed the cash price. Patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the insurance negotiated rates can sometimes be higher than the out-of-pocket cash cost.
To minimize costs, patients should verify if the facility offers self-pay or prompt-pay discounts, which can reduce the bill by 20% to 50% when paid upfront. It is also important to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be corrected. Since this facility is a Critical Access Hospital in Ellsworth, Kansas, and operates under proprietary ownership, comparing the final allowed amount to the local county or state averages is essential to ensure fair pricing. Always confirm your deductible status and whether the specific insurance plan has a contract with the facility before scheduling to avoid unexpected balance billing.