Colonoscopy (diagnostic)
Facility: Regional Medical Center
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $870
- Cash Discount Price: $3,256
- vs. Medicare Baseline: 0.92x 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 |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 92% |
Consumer Guidance & Cost Commentary
Regional Medical Center in Manchester, Iowa, performed a diagnostic colonoscopy with a cash median price of $3,256. This cash rate is notably lower than the facility's gross charge of $4,071 and aligns closely with the median paid amount of $3,381. For patients with high-deductible plans, paying the cash price of $3,256 upfront may be more cost-effective than using insurance, which resulted in a negotiated rate of $870 paid by Medical Associates Health Plan - Tri but could involve higher out-of-pocket costs if the patient's deductible was not yet met.
It is important for consumers to verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these can further reduce the final balance. While the facility's cash rate is lower than the gross charge, patients should be aware that commercial negotiated rates often include administrative overhead that can inflate the baseline price. If a patient receives a bill significantly higher than these figures, they should request a detailed itemized audit to identify any unbundled codes or services not rendered, ensuring they are not subject to unexpected balance billing beyond what their plan covers.