Colonoscopy (diagnostic)
Facility: Cloud County Health Center
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $504
- Cash Discount Price: $591
- 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 |
|---|---|---|
| Mpi-All Plans | $207 | 22% |
| Pponext-All Plans | $802 | 84% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Cloud County Health Center in Concordia, KS, the facility's cash median rate of $591 is lower than the Medicare benchmark of $950.10, suggesting a fair pricing structure relative to the federal cost baseline. While the facility is a Critical Access Hospital with a voluntary non-profit ownership, the negotiated rates for in-network payers like Mpi-All Plans and Pponext-All Plans average $504, which is significantly lower than the gross charge of $844. Patients with high-deductible plans may find the cash price of $591 more affordable than the negotiated rate of $802, as the insurance process often involves administrative fees that can inflate the final cost. It is important to verify your specific plan's deductible status before scheduling, as paying the negotiated rate without meeting your deductible could result in higher out-of-pocket expenses than paying cash directly.
To ensure you are receiving the best possible rate, we recommend asking the hospital about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% if paid upfront. These discounts bypass the costly insurance claims cycle, saving the facility administrative overhead and providing immediate liquidity. Additionally, since over 80% of hospital bills contain errors, we advise requesting a full itemized CPT-coded statement before making any payment to identify any unbundled charges or services not rendered. While the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to confirm that your specific procedure code, 45378, is correctly classified and that no unexpected ancillary services will trigger additional charges