Colonoscopy (diagnostic)
Facility: Girard Medical Center
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $154
- Cash Discount Price: $673
- vs. Medicare Baseline: 0.16x 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 | $154 - $237 | 16% |
| Kansas Superior Select-All Plans | $154 | 16% |
| Humana | $154 | 16% |
| Blue Cross Blue Shield | $154 - $432 | 16% |
| Aetna | $154 | 16% |
| Medicare (plans) | $154 | 16% |
| Ambetter / Centene | $154 | 16% |
| Uhhis-All Plans | $237 | 25% |
| Multiplan-All Plans | $1,038 | 109% |
Consumer Guidance & Cost Commentary
For the diagnostic colonoscopy procedure at Girard Medical Center, the negotiated rates across nine insurance plans range from $154 to $1,038, with a median negotiated amount of $154. This median negotiated rate is significantly lower than the facility's gross charge of $1,122, reflecting standard insurance contract caps. However, for patients without insurance or with high-deductible plans, the cash price of $673 may be more cost-effective than the insurance allowed amount, which can sometimes exceed the cash rate depending on the specific plan's coverage. It is important to note that while the facility is an in-network Critical Access Hospital in Kansas, the actual amount a patient pays depends heavily on their individual deductible status and the specific terms of their insurance contract.
To minimize out-of-pocket costs, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the total bill by 20% to 50%. Since over 80% of hospital bills contain errors, patients should always demand a full itemized CPT-coded statement rather than accepting a summary bill, which may hide unbundled charges or services not rendered. Additionally, because the facility is a government-owned Critical Access Hospital, the Medicare benchmark of $950.1 serves as a reliable baseline for evaluating pricing fairness; commercial rates should be compared against this federal standard rather than the inflated chargemaster list price to ensure transparency and avoid unexpected balance billing.