Colonoscopy (diagnostic)
Facility: Clay County Medical Center
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $781
- Cash Discount Price: $840
- vs. Medicare Baseline: 0.82x 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 |
|---|---|---|
| Multiplan- All Plans | $170 - $798 | 18% |
| Wppa/Providrs Care- All Plans | $232 - $781 | 24% |
| UnitedHealthcare | $433 - $798 | 46% |
| Health Partners - All Plans | $662 - $798 | 70% |
| Aetna | $781 | 82% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Clay County Medical Center in Clay Center, KS, the cash price is $840, which matches the facility's median negotiated rate of $781 and the cash median. This service is billed under CPT code 45378, and while the facility is a Critical Access Hospital owned by the local government, the negotiated rates for in-network payers like UnitedHealthcare and Aetna range from $433 to $781. It is important to note that commercial negotiated rates often exceed cash prices due to administrative costs and contract structures; however, patients with high-deductible plans may find paying the cash price of $840 more cost-effective if their insurance allowed amount is higher than the cash rate. Always verify your specific plan's deductible status and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can significantly reduce out-of-pocket costs.
When evaluating the cost of this procedure, it is crucial to compare rates against the Medicare benchmark rather than the hospital's gross chargemaster list. The Medicare amount for this code is $950.10, which serves as the objective baseline for fair pricing; commercial rates are typically marked up significantly above this figure, with fair pricing generally defined as 120% to 150% of the Medicare rate. Although the provided data does not include explicit county or state average comparisons for this specific code, patients should be aware that balance billing can occur if out-of-network services are rendered, even at an in-network facility, though the No Surprises Act protects against surprise bills for emergency and non-emergency care at in-network hospitals. To