Colonoscopy (diagnostic)
Facility: Hiawatha Community Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $246
- Cash Discount Price: $761
- vs. Medicare Baseline: 0.26x 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 |
|---|---|---|
| Ambetter / Centene | $151 | 16% |
| UnitedHealthcare | $154 - $190 | 16% |
| Aetna | $154 - $425 | 16% |
| Humana | $154 | 16% |
| Centrus Health Direct - All Plans | $184 | 19% |
| Multiplan - All Plans | $230 | 24% |
| Oscar - All Plans | $246 | 26% |
| Wppa Providrs Care - All Plans | $411 | 43% |
| Midlands Choice - All Plans | $423 | 45% |
| Preferred Hlth - All Plans | $480 | 51% |
| Cigna | $662 | 70% |
| Healthy Blue Mcaid - All Plans | $688 - $833 | 72% |
Consumer Guidance & Cost Commentary
For patients with high-deductible plans, paying cash upfront for this diagnostic colonoscopy at Hiawatha Community Hospital may be the most cost-effective option. The facility's cash price of $761.00 is significantly lower than the negotiated rates charged to in-network insurers, which range from $151 to $833 depending on the plan. While the state average for this service is not explicitly listed, the facility's cash rate is notably lower than the highest negotiated rates found among the 12 payers, such as Healthy Blue Mcaid's range of $688 to $833. Patients should contact the hospital directly to confirm if a "self-pay" or "prompt-pay" discount is available, as paying in full before or shortly after the service can often reduce the final bill by 20% to 50% by bypassing administrative claim processing fees.
This facility's pricing is also evaluated against the Medicare benchmark, which serves as a federal cost baseline for this procedure. The Medicare amount is $950.10, and the facility's cash rate of $761.00 is 20% lower than this benchmark, indicating a pricing structure that aligns closely with fair market value rather than the inflated chargemaster lists often used for comparison. In contrast, the median negotiated rate across all payers is $246.00, which is substantially lower than both the cash price and the Medicare amount; however, this lower figure represents the maximum allowed amount for insured members, not necessarily the actual out-of-pocket cost for patients who have not yet met their deductibles. Consumers are advised to verify their specific deductible status and request an