Colonoscopy (diagnostic)
Facility: Wamego Health Center
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $235
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.25x 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 |
|---|---|---|
| Providrs Care | $213 - $427 | 22% |
| UnitedHealthcare | $225 | 24% |
| Medicaid / KanCare | $234 - $236 | 25% |
| Aetna | $234 | 25% |
| Tricare | $691 | 73% |
| Blue Cross Blue Shield | $1,735 - $1,826 | 183% |
Consumer Guidance & Cost Commentary
For the diagnostic colonoscopy procedure at Wamego Health Center in Wamego, KS, the facility's negotiated rates range from $213 to $691 depending on the payer, with a median negotiated rate of $235.00. While the facility is a Critical Access Hospital, the data provided does not include specific state or county average figures for this procedure, so a direct comparison to regional benchmarks cannot be made at this time. It is important to note that commercial insurance contracts often result in higher out-of-pocket costs than cash prices due to administrative overhead and contract structures; however, without a listed cash median or state average, patients cannot yet determine if paying out-of-pocket would be financially advantageous.
The Medicare benchmark for this service is $950.10, which serves as the objective baseline for evaluating pricing markups. Commercial negotiated rates in this dataset average between 20% and 70% of the Medicare amount, which falls within the typical range for fair pricing (120% to 150% of Medicare) rather than the higher commercial markups often seen. Patients should verify their specific plan details, as deductibles and copays can significantly impact the final cost even when using in-network coverage. Additionally, if you are self-paying, you should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can reduce the total bill by 20% to 50% by bypassing costly insurance claims processing.