Colonoscopy (diagnostic)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $1,178
- Cash Discount Price: $844
- vs. Medicare Baseline: 1.24x 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 |
|---|---|---|
| Medicaid / KanCare | $154 - $1,900 | 16% |
| UnitedHealthcare | $154 - $1,900 | 16% |
| Va Ccn - All Plans | $154 - $1,178 | 16% |
| Aetna | $154 - $1,710 | 16% |
| Tricare | $154 - $1,005 | 16% |
| Ambetter / Centene | $161 - $1,296 | 17% |
| Healthy Blue Mcaid - All Plans | $225 - $1,900 | 24% |
| Humana | $931 | 98% |
| Health Partners - All Plans | $1,805 | 190% |
| Blue Cross Blue Shield | $1,807 | 190% |
Consumer Guidance & Cost Commentary
For the diagnostic colonoscopy procedure (CPT 45378) at Trego County Lemke Memorial Hospital, the cash price of $844.00 is lower than the facility's gross charge of $993.00. While the hospital is a Critical Access Hospital in Wakeeney, KS, with government-local ownership, the cash rate is notably lower than the median negotiated rate of $1,178.00 paid by insurance plans. Patients with high-deductible plans or those without insurance may find the cash price more affordable, as it avoids the administrative markup inherent in insurance billing. It is important to note that while the facility offers a cash rate, patients should explicitly ask for "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the cost by bypassing the costly claims processing cycle.
Commercial insurance rates for this service vary significantly across payers, ranging from $154 to $1,900, with most plans falling between $154 and $1,296. The Medicare benchmark for this code is $950.10, which serves as a reliable baseline for evaluating pricing fairness rather than the hospital's inflated gross charges. Although the facility's cash rate is below the Medicare amount, the median negotiated rate of $1,178.00 exceeds the Medicare benchmark, reflecting the typical administrative load and contract dynamics that inflate commercial rates. Consumers should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but they must still verify their specific plan's allowed amount and deductible status to avoid unexpected out