Colonoscopy (diagnostic)
Facility: Phillips County Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $1,459
- Cash Discount Price: $1,056
- vs. Medicare Baseline: 1.54x 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 |
|---|---|---|
| Medicaid / KanCare | $225 - $1,824 | 24% |
| UnitedHealthcare | $225 - $1,824 | 24% |
| Midlands Choice Profee Only-All Plans | $423 | 45% |
| Blue Cross Blue Shield | $1,321 - $1,477 | 139% |
| Health Partners-All Plans | $1,824 | 192% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Phillips County Hospital, the cash price of $1,056 is notably lower than the facility's negotiated rates, which range from $423 to $1,824 depending on the insurance plan. While the median negotiated amount paid by insurers is $1,477, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds this figure. It is important to note that the facility's cash rate is 1.5 times the Medicare benchmark of $950.1, indicating a markup relative to the federal baseline. Additionally, the facility is a Critical Access Hospital in Phillipsburg, Kansas, with government-local ownership, which often influences pricing structures compared to larger regional centers.
To maximize savings, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. Waiting until after receiving an insurance bill to ask for a discount is a common pitfall, as billing systems may automatically submit claims that void the cash agreement. Furthermore, while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, it is crucial to review itemized bills carefully to ensure no unbundled codes or services not rendered are included. Given that over 80% of hospital bills contain errors, requesting a detailed, line-by-line audit before paying is an effective way to identify and correct potential overcharges.