Colonoscopy (diagnostic)
Facility: Great Plains Of Sabetha
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $506
- Cash Discount Price: $527
- vs. Medicare Baseline: 0.53x 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 |
|---|---|---|
| Celtic Mcr Adv | $154 - $1,043 | 16% |
| Aetna | $155 - $2,025 | 16% |
| UnitedHealthcare | $155 - $2,005 | 16% |
| Celtic Comm Exchange-All Other Plans | $192 - $1,303 | 20% |
| Medicaid / KanCare | $225 - $2,005 | 24% |
| Great West Healthcare-All Plans | $435 - $1,704 | 46% |
| Century/Wppa/Providers-All Plans | $461 - $1,905 | 49% |
| Multiplan-Phcs-All Plans | $486 - $1,905 | 51% |
| Federated Mutual Ins-All Plans | $492 - $1,925 | 52% |
| Cigna | $501 - $1,905 | 53% |
| Humana | $501 - $1,905 | 53% |
| Blue Cross Blue Shield | $527 - $2,005 | 55% |
Consumer Guidance & Cost Commentary
For this diagnostic colonoscopy at Great Plains Of Sabetha, the cash price is $527, which matches the facility's cash median. This rate is significantly lower than the state average for this procedure, as the Medicare benchmark of $950.10 serves as the objective baseline for fair pricing. While commercial insurance plans like Aetna and UnitedHealthcare have negotiated rates ranging from $155 to over $2,000, patients with high-deductible plans may find the cash price more affordable if their insurance allowed amount exceeds $527. It is important to note that commercial negotiated rates often include administrative overhead and can be higher than the cash price due to complex billing cycles; therefore, self-pay patients should explicitly ask the hospital about "prompt-pay" discounts before scheduling to potentially reduce the final cost.
Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, unexpected charges can still occur if ancillary services like labs or emergency care are billed separately. To avoid errors, consumers should request a full itemized bill before paying, as summary invoices often hide unbundled codes or services not rendered. Since over 80% of hospital bills contain mistakes, disputing charges in writing with a certified letter to the billing supervisor is the most effective way to resolve discrepancies. Additionally, because this facility is a Critical Access Hospital in Kansas, its pricing structure is designed to reflect local cost realities, making the $527 cash rate a strong reference point for evaluating the facility's overall value compared to regional averages.