Colonoscopy (diagnostic)
Facility: Kiowa District Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $1,607
- Cash Discount Price: $1,360
- vs. Medicare Baseline: 1.69x 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 |
|---|---|---|
| Tricare | $663 | 70% |
| Healthchoice-All Plans | $1,299 | 137% |
| Blue Cross Blue Shield | $1,308 | 138% |
| UnitedHealthcare | $1,360 - $1,700 | 143% |
| Health Partners Of Ks-All Plans | $1,496 | 157% |
| Humana | $1,534 | 161% |
| Gbs Insurance - All Plans | $1,598 | 168% |
| Multiplan-All Plans | $1,598 | 168% |
| Medicare (plans) | $1,615 | 170% |
| Triwest-All Plans | $1,615 | 170% |
| Aetna | $1,615 | 170% |
| Medicaid / KanCare | $1,700 | 179% |
| Providers Care (Wppa)-All Plans | $2,550 | 268% |
| Liberty Healthshare-All Plans | $2,746 | 289% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Kiowa District Hospital, the cash median price is $1,360, which is lower than the negotiated rates paid by most in-network insurers. While the facility's cash rate is below the gross charge of $1,700, many commercial payers, including UnitedHealthcare and Humana, negotiate rates ranging from $1,534 to $1,700. This pricing structure highlights a common billing dynamic where cash-pay options can be more cost-effective for patients with high-deductible plans or those without insurance, as the cash price avoids the administrative markup and contract ceilings that often inflate insurance negotiated rates. Patients should verify their specific plan's deductible status before scheduling, as paying the full negotiated amount may not be covered until that threshold is met.
The facility's pricing is benchmarked against the Medicare rate of $950.10, which serves as a scientifically validated baseline for healthcare costs. The cash median of $1,360 represents a 43% increase over the Medicare amount, while the median negotiated rate of $1,598 reflects a 67% markup. Given that fair pricing is typically defined as 120% to 150% of the Medicare rate, the current cash and negotiated rates exceed these benchmarks. To minimize costs, patients should explicitly request a "self-pay" or "prompt-pay" discount at registration, which can reduce the bill by 20% to 50% by bypassing insurance claims processing. Additionally, if a patient receives a bill after insurance payment, they should request an itemized audit to ensure no balance billing errors or unbundled charges exist, as over