CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Harlan County Health System

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $821
Cash Discount Price: $1,344
vs. Medicare Baseline: 0.86x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Harlan County Health System is $821. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,344. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.86x the Medicare baseline. Located in 717 Brown St, Alma, NE.

Cash / Self-Pay

$1,344

Average discount available for prompt cash payment at this facility.

Insurance Median

$821

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$950.1

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $950.1 (100%)

Cash / Self-Pay: $1,344 (141%)

Insurance Median: $821 (86%)

Cash: $1,344 (141% of Medicare)

Ins. Median: $821 (86% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$153 - $1,065	16%
Medica Chi Health	$153 - $1,384	16%
Medica Mcr Adv	$153 - $821	16%
Medica Prime Solution	$153 - $821	16%
Tricare	$153 - $1,019	16%
UnitedHealthcare	$153 - $1,839	16%
Great Plains Mcr Adv-All Plans	$160 - $1,070	17%
Medica Ifb Aco	$277 - $1,460	29%
Blue Cross Blue Shield	$292 - $1,460	31%
Medica Chi Aco - All Other Plans	$292 - $1,384	31%
Medica Choice	$305 - $1,384	32%
Medica Ifb Open Access	$354 - $1,460	37%
Phcs/Multiplan-All Plans	$457 - $1,491	48%
Humana	$1,019	107%
Ohara Llc Wc- All Plans	$1,445 - $1,747	152%
Ambetter / Centene	$1,876	197%
Healthy Blue Mcaid-All Plans	$1,931	203%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,344.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Harlan County Health System is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45378.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.