Colonoscopy (diagnostic)
Facility: Fredonia Regional Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $1,048
- Cash Discount Price: $1,405
- vs. Medicare Baseline: 1.10x 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 | $152 - $1,321 | 16% |
| Veterans Programs - All Plans | $152 - $1,048 | 16% |
| Aetna | $385 - $1,849 | 41% |
| Cigna | $680 - $1,849 | 72% |
| Reserve National-All Plans | $680 - $1,849 | 72% |
| Meritain-All Plans | $680 - $1,849 | 72% |
| UnitedHealthcare | $680 - $1,849 | 72% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Fredonia Regional Hospital in Fredonia, Kansas, the cash price is $1,405, which matches the facility's median negotiated rate. This cash price is significantly higher than the Medicare benchmark of $950.10, indicating a markup of 110% over the federal baseline. While the facility is a Critical Access Hospital with government local ownership, the data shows that commercial insurance negotiated rates for this service range from $152 to $1,849 across seven payers. Notably, the lowest negotiated rates observed were $152 for Blue Cross Blue Shield and Veterans Programs, which are substantially lower than the cash price, suggesting that for patients with high-deductible plans, paying the cash rate of $1,405 upfront could result in lower out-of-pocket costs compared to insurance claims that may exceed the cash price due to administrative overhead and contract dynamics.
Patients should be aware that while the facility offers a cash price, commercial insurance contracts often create a ceiling that limits what insurers will pay, sometimes resulting in higher net costs for the patient if their deductible has not been met. It is crucial to verify your specific plan's allowed amount before scheduling, as in-network rates vary widely among carriers. Additionally, since this is a non-emergency procedure, you may be eligible for a prompt-pay discount if you pay the bill in full within a short window, which could further reduce the $1,405 cash price. Given that over 80% of hospital bills contain errors, we strongly recommend requesting a detailed, itemized bill before making any payments to ensure no unbundled codes or services not rendered are included in the final charge