Colonoscopy (diagnostic)
Facility: Stevens County Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $1,807
- Cash Discount Price: $2,077
- vs. Medicare Baseline: 1.90x 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 |
|---|---|---|
| Humana | $768 | 81% |
| Aetna | $792 - $2,077 | 83% |
| Blue Cross Blue Shield | $1,255 - $1,321 | 132% |
| First Health - All Plans | $1,869 | 197% |
| Wppa - All Plans | $1,973 | 208% |
| Medicaid / KanCare | $2,077 | 219% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Stevens County Hospital in Hugoton, Kansas, the cash price is $2,077, which matches the facility's gross chargemaster rate. While commercial payers like Aetna and Blue Cross Blue Shield have negotiated rates ranging from $792 to $2,077, the cash price remains the highest figure in this dataset. It is important to note that for patients with high-deductible plans, paying the cash price directly can sometimes be more affordable than relying on insurance, as the insurer's allowed amount may exceed the cash rate. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can significantly lower the final cost.
This service is priced at 1.9 times the Medicare benchmark of $950.10, indicating a significant markup relative to the federal government's cost-based reimbursement. The facility, a Critical Access Hospital owned by the local government, lists a median negotiated payment of $1,807 across six payers, though the cash rate remains the same. Given that over 80% of hospital bills often contain errors, patients should request a detailed, itemized statement rather than accepting a summary bill to ensure no unbundled codes or services not rendered are included. If a balance bill arises from out-of-network ancillary services, patients should verify the legality of the charge under the No Surprises Act before paying immediately, as federal protections may apply to emergency or non-emergency care at in-network facilities.