Colonoscopy (diagnostic)
Facility: William Newton Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $154
- Cash Discount Price: $810
- vs. Medicare Baseline: 0.16x 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 |
|---|---|---|
| Triwest- All Plans | $146 | 15% |
| UnitedHealthcare | $154 | 16% |
| Blue Cross Blue Shield | $154 | 16% |
| Ambetter / Centene | $177 - $307 | 19% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at William Newton Hospital in Winfield, KS, the cash price is $810, which matches the facility's median negotiated rate of $154 when compared to the state average. While the facility is a Critical Access Hospital with a government-local ownership structure, patients should note that cash payments can sometimes be more cost-effective than using insurance if their plan's negotiated rate exceeds the cash price. Although the Medicare benchmark for this service is $950.10, commercial rates often vary significantly; in this case, the cash rate is lower than the Medicare amount, suggesting that paying out-of-pocket might result in a lower total cost for those without high-deductible plans.
It is important to verify your specific insurance coverage before scheduling, as negotiated rates can differ even within the same network. The data shows a range of $146 to $307 across four payers, with some plans like Ambetter / Centene having a wider variance. To potentially lower your bill, you should ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the final amount by 20% to 50% if paid in full upfront. Additionally, if you have insurance, ensure you have an itemized bill rather than a summary to avoid errors or unbundled charges, and remember that the No Surprises Act protects you from balance billing for out-of-network providers at in-network facilities.