CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Phelps Memorial Health Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,565
Cash Discount Price: $1,433
vs. Medicare Baseline: 1.65x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Phelps Memorial Health Center is $1,565. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,433. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.65x the Medicare baseline. Located in 1215 Tibbals St, Holdrege, NE.

Cash / Self-Pay

$1,433

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,565

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$950.1

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $950.1 (100%)

Cash / Self-Pay: $1,433 (151%)

Insurance Median: $1,565 (165%)

Cash: $1,433 (151% of Medicare)

Ins. Median: $1,565 (165% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$153 - $3,458	16%
Good Samaritan Mcr Adv - All Plans	$153 - $1,565	16%
Medica Mcr Adv	$153 - $1,565	16%
UnitedHealthcare	$153 - $3,531	16%
Va Ccn - All Plans	$153 - $1,565	16%
Wellcare Mcr Adv - All Plans	$153 - $1,565	16%
Three Rivers - All Plans	$183 - $1,878	19%
Provider Network Of American - All Plans	$229 - $3,385	24%
Partners Hlth Alliance - All Plans	$267 - $2,912	28%
6 Degrees Hlth - All Plans	$275 - $2,912	29%
Medica-All Other Plans	$275 - $3,422	29%
Ambetter / Centene	$278 - $4,070	29%
Midwest Ntwrk Alliance - All Plans	$290 - $3,458	31%
Providrs Care/Wppa - All Plans	$349 - $3,276	37%
Aetna	$360 - $3,356	38%
First Health - All Plans	$812 - $3,462	85%
Molina Mcaid - All Plans	$854 - $1,602	90%
Cpi Benefit Group-All Plans	$3,276	345%
Chi Health Partners - All Plans	$3,458	364%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,433.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Phelps Memorial Health Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45378.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.