Colonoscopy (diagnostic)
Facility: Bob Wilson Memorial Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $1,763
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.86x 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 |
|---|---|---|
| Blue Cross Blue Shield | $1,763 | 186% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Bob Wilson Memorial Hospital in Ulysses, KS, the negotiated rate for Blue Cross Blue Shield is $1,763, which is significantly higher than the Medicare benchmark of $950.10. This indicates a markup of 1.9 times the Medicare rate, reflecting the administrative costs and contract dynamics typical of in-network billing. While the facility is a voluntary non-profit Critical Access Hospital, patients should be aware that cash-pay options are not listed in this report; however, for individuals with high-deductible plans, direct payment might be more cost-effective if the facility offers a self-pay or prompt-pay discount that brings the price below the insurance negotiated rate. It is crucial to contact the hospital directly before scheduling to inquire about these potential cash discounts and to ensure your plan is properly classified as self-pay to avoid automatic claims submission.
Patients should exercise caution regarding balance billing and billing errors, as over 80% of hospital bills contain mistakes that can lead to unexpected debt. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is essential to request a full, itemized CPT-coded bill before agreeing to any payment plan or signing consent waivers. This detailed statement allows you to identify unbundled codes, services not rendered, or double-charges that may have occurred during the procedure. If you receive a summary bill or a balance bill that appears excessive, you should dispute the charges in writing with the billing supervisor rather than accepting the amount immediately, ensuring that your rights under federal protections and fair pricing standards are maintained.