Colonoscopy (diagnostic)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $551
- Cash Discount Price: $1,373
- vs. Medicare Baseline: 0.58x 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 |
|---|---|---|
| Aetna | $154 - $1,208 | 16% |
| UnitedHealthcare | $169 - $864 | 18% |
| Blue Cross Blue Shield | $408 - $1,321 | 43% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Community Memorial Healthcare, Inc. in Marysville, KS, the cash price is $1,373, which matches the facility's median paid amount. While the facility's negotiated rates with major payers like Aetna, UnitedHealthcare, and Blue Cross Blue Shield range from $154 to $1,321, these amounts are often higher than the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find paying the cash price directly more cost-effective than using insurance, as the negotiated allowed amounts can exceed the cash rate. Additionally, this facility is a Critical Access Hospital with a voluntary non-profit ownership structure, and while the facility holds a 4-star rating, patients should verify their specific plan's deductible status before scheduling to avoid unexpected out-of-pocket costs.
To minimize potential billing surprises, consumers should request an itemized bill before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Although the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, it is still advisable to dispute any unexpected charges in writing rather than accepting summary bills or verbal assurances. Furthermore, patients should inquire about prompt-pay discounts, which can reduce the total cost by 20% to 50% if paid upfront, bypassing the costly claims processing cycle that inflates insurance-based billing. By comparing the cash price of $1,373 against the Medicare benchmark of $950.10, patients can better understand the facility's pricing relative to the federal cost baseline, ensuring they are not overpaying for essential care.