Colonoscopy (diagnostic)
Facility: Hodgeman County Health Center
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $1,436
- Cash Discount Price: $1,632
- vs. Medicare Baseline: 1.51x 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 |
|---|---|---|
| Blue Cross Blue Shield | $1,255 - $1,321 | 132% |
| Medicaid / KanCare | $1,306 - $2,040 | 137% |
| UnitedHealthcare | $1,306 - $1,938 | 137% |
| Triwest - All Plans | $1,306 | 137% |
| Humana | $1,306 | 137% |
| Aetna | $1,632 | 172% |
| First Health - All Plans | $1,836 | 193% |
| Health Partners - All Plans | $1,938 | 204% |
| Wppa (Provdrscare) - All Plans | $1,938 | 204% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Hodgeman County Health Center in Jetmore, Kansas, the facility's cash price of $1,632 is significantly lower than the negotiated rates charged by most major insurance payers, which range from $1,306 to $2,040. While Medicaid/KanCare and UnitedHealthcare offer the lowest negotiated rates at $1,306, many other plans, including Blue Cross Blue Shield and First Health, pay substantially more, with First Health's rate of $1,836 exceeding the cash price. This pricing structure highlights that for patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price directly can result in immediate savings compared to the insurance negotiated rate. Additionally, patients should verify if the facility offers a "prompt-pay" discount, which could further reduce the final amount owed if settled upfront.
It is important to note that the facility's cash price of $1,632 is higher than the state of Kansas average for this procedure, which is $1,436, though it aligns closely with the national median paid amount of $1,436. When comparing the facility's rates to the Medicare benchmark of $950.10, the cash price represents a markup of approximately 1.5 times the Medicare rate, which falls within the typical range for commercial pricing. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, they should still request an itemized bill to ensure no unbundled charges or services not rendered are included. If a patient receives a summary bill, they should demand