Colonoscopy (diagnostic)
Facility: Osborne County Memorial Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $1,678
- Cash Discount Price: $1,576
- vs. Medicare Baseline: 1.77x 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 | $1,409 | 148% |
| Health Partners Of Kansas | $1,594 | 168% |
| Wppa | $1,761 | 185% |
| Blue Cross Blue Shield | $1,817 | 191% |
Consumer Guidance & Cost Commentary
For the diagnostic colonoscopy procedure at Osborne County Memorial Hospital in Osborne, KS, the facility's cash price of $1,576 is notably higher than the state average, which sits at $1,409. While the hospital is a Critical Access Hospital with government-local ownership, patients should be aware that commercial insurance rates often exceed cash prices due to administrative overhead and contract structures. In this case, the lowest negotiated rate among the four payers is $1,409, which matches the state average, but the median negotiated rate is $1,678. If you have a high-deductible plan or have not yet met your deductible, paying the cash price might be more cost-effective than relying on insurance, as the insurer's allowed amount could still result in a higher out-of-pocket expense than the direct cash rate.
The facility's Medicare benchmark rate of $950.1 serves as a critical baseline for evaluating pricing fairness, showing that the cash price represents a markup of approximately 1.8 times the Medicare amount. This aligns with the broader industry pattern where commercial rates often range between 200% and 300% of Medicare, though fair pricing is typically defined as 120% to 150%. To potentially lower your final bill, we recommend asking the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce costs by 20% to 50% for upfront payments. Additionally, since over 80% of hospital bills contain errors, it is advisable to request a full itemized statement before paying to ensure no unbundled codes or services not rendered are included in the total.