Colonoscopy (diagnostic)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $361
- Cash Discount Price: $448
- vs. Medicare Baseline: 0.38x 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 |
|---|---|---|
| UnitedHealthcare | $163 - $560 | 17% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Hospital District #6 Patterson Health Center in Anthony, KS, the cash median price is $448.00, which is lower than the facility's gross charge of $560.00. While the Medicare benchmark for this service is $950.10, the negotiated rate for UnitedHealthcare is capped at $560.00, meaning in-network members will not pay the full list price. Patients with high-deductible plans may find paying the cash median of $448.00 directly more cost-effective than relying on insurance, as the negotiated rate exceeds the cash price. It is important to verify your specific plan's deductible status before scheduling, as paying out-of-pocket can sometimes result in immediate savings compared to the administrative costs and potential out-of-pocket maximums associated with insurance claims.
To ensure you are not overcharged, always request a full itemized bill before finalizing payment, as summary bills often obscure individual line items and potential errors. If you receive a balance bill for services rendered at this Critical Access Hospital, remember that the No Surprises Act generally prohibits providers from charging you the difference between their chargemaster rate and your insurance allowed amount for emergency or non-emergency care at in-network facilities. Additionally, ask the billing department about prompt-pay discounts, which can reduce your total bill by 20% to 50% if you pay in full upfront, bypassing the slower insurance claims cycle and avoiding unnecessary administrative fees.