Colonoscopy (diagnostic)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $1,686
- Cash Discount Price: $1,781
- vs. Medicare Baseline: 1.77x 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 | $1,383 - $1,469 | 146% |
| Humana | $1,571 - $1,670 | 165% |
| Aetna | $1,597 - $1,835 | 168% |
| UnitedHealthcare | $1,640 - $1,743 | 173% |
| Hpk-All Plans | $1,640 - $1,743 | 173% |
| Medicaid / KanCare | $1,727 - $1,835 | 182% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Medicine Lodge Memorial Hospital in Medicine Lodge, KS, the cash price is $1,781, which matches the facility's median negotiated rate. This cash price is significantly higher than the state average for this procedure, as indicated by the Medicare benchmark ratio of 1.8, suggesting the facility's rates are nearly double the federal baseline. While commercial insurance plans like Aetna and Humana negotiate rates ranging from $1,383 to $1,835, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket and seeking prompt-pay discounts before the insurance claim is processed.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care at in-network facilities, unexpected charges can still arise from out-of-network ancillary services like emergency physicians or lab tests. To avoid these surprises, it is crucial to request a full itemized bill before paying, as summary invoices may hide unbundled codes or services not rendered. If you choose to pay cash, ask the hospital about self-pay or prompt-pay discounts upfront, as paying in full within a short window can reduce the total cost by bypassing administrative fees and insurance claim delays. Always verify your deductible status and request a written waiver of insurance submission to ensure you are not accidentally triggering a higher negotiated rate.