Colonoscopy (diagnostic)
Facility: Sheridan County Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $2,221
- Cash Discount Price: $3,671
- vs. Medicare Baseline: 2.34x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 234% of the Medicare baseline (a markup of 134%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Blue Cross Blue Shield | $1,820 | 192% |
| Celtic Insurance | $2,221 | 234% |
| UnitedHealthcare | $3,487 | 367% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Sheridan County Hospital in Hoxie, KS, the cash price is $3,671, which matches the facility's median paid amount. While this cash rate is significantly higher than the state average for this procedure, it is important to note that commercial insurance plans often pay negotiated rates that exceed the cash price. For instance, Celtic Insurance's negotiated rate of $2,221 is lower than the cash price, but UnitedHealthcare's rate of $3,487 is still below the cash price, whereas Blue Cross Blue Shield's rate of $1,820 is the lowest among the three payers. Patients with high-deductible plans should consider paying the cash price directly, as it may be cheaper than their insurance's negotiated rate once deductibles and copays are factored in. Additionally, patients should always ask the hospital about self-pay or prompt-pay discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
The Medicare benchmark for this service is $950.10, which serves as a reliable baseline for evaluating the facility's pricing. The facility's cash price of $3,671 represents a markup of 2.3 times the Medicare rate, indicating a significant difference between the government's cost-based reimbursement and commercial pricing. Since over 80% of hospital bills contain errors, patients should request a detailed, itemized bill to identify any unbundled codes, services not rendered, or double-charges before agreeing to payment. If a balance bill arises from an out-of-network provider, patients should not pay immediately out of fear of credit damage; instead, they should dispute the bill with their insurer and request