Colonoscopy (diagnostic)
Facility: Smith County Memorial Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $1,907
- Cash Discount Price: $2,029
- vs. Medicare Baseline: 2.01x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 201% of the Medicare baseline (a markup of 101%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $1,308 | 138% |
| Medicaid / KanCare | $1,420 - $2,029 | 149% |
| Multiplan-All Plans | $1,826 | 192% |
| Wppa-All Plans | $1,907 | 201% |
| Health Partners Of Ks Ppo-All Plans | $1,927 | 203% |
| UnitedHealthcare | $1,927 | 203% |
| Midlands Choice-All Plans | $1,927 | 203% |
Consumer Guidance & Cost Commentary
For the diagnostic colonoscopy procedure at Smith County Memorial Hospital, the cash price of $2,029 is notably higher than the state average for this service. While the facility's cash rate aligns with its own cash median, patients with high-deductible plans may find paying out-of-pocket cheaper if their insurance negotiated rate exceeds this amount. It is important to note that the hospital's negotiated rate for Medicaid/KanCare is $1,420, which is lower than the cash price, suggesting that using insurance coverage could result in lower out-of-pocket costs for those eligible. Additionally, the facility offers a prompt-pay discount for upfront payments, which can reduce the total bill by 20% to 50% and bypass costly administrative fees associated with insurance claims processing.
The Medicare benchmark for this procedure is $950.10, which serves as a reliable baseline for evaluating the facility's pricing structure. The hospital's cash rate of $2,029 represents a significant markup compared to the federal government's fixed reimbursement rate, highlighting the difference between commercial pricing and the true cost of care. Patients should request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Furthermore, if you have out-of-network services billed, the No Surprises Act may protect you from balance billing, so it is advisable to dispute any unexpected charges with your insurer rather than paying immediately.