Colonoscopy (diagnostic)
Facility: Memorial Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $161
- Cash Discount Price: $844
- vs. Medicare Baseline: 0.17x 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 |
|---|---|---|
| Tricare | $154 | 16% |
| Ambetter / Centene | $169 | 18% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Memorial Hospital in Abilene, KS, the cash price is $844.00, which matches the facility's median negotiated rate. This cash amount is lower than the Medicare benchmark of $950.10, indicating that paying out-of-pocket may be more cost-effective than using insurance for this service. While the facility is a Critical Access Hospital with a government ownership structure, patients should verify if their specific plan has a deductible that would require them to pay the full negotiated rate before coverage begins. It is important to note that commercial insurance negotiated rates often include administrative overhead and can sometimes exceed cash prices, making direct payment a viable option for those with high-deductible plans.
Before finalizing any payment, consumers should request a prompt-pay discount, which can reduce the bill by 20% to 50% if paid in full upfront. Additionally, if you have insurance, ensure you receive an itemized bill rather than a summary invoice, as hospitals may bundle charges or include services not rendered. Since the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, you should not sign away your rights to dispute unexpected charges. Always contact the hospital directly to confirm self-pay rates and any available discounts before scheduling your appointment.