CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Phelps Memorial Health Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,155
Cash Discount Price: $1,040
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Phelps Memorial Health Center is $1,155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,040. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.94x the Medicare baseline. Located in 1215 Tibbals St, Holdrege, NE.

Cash / Self-Pay

$1,040

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,155

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$1,222.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $1,222.56 (100%)

Cash / Self-Pay: $1,040 (85%)

Insurance Median: $1,155 (94%)

Cash: $1,040 (85% of Medicare)

Ins. Median: $1,155 (94% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $1,222.56 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	$165 - $3,660	13%
Good Samaritan Mcr Adv - All Plans	$165 - $1,657	13%
Medica Mcr Adv	$165 - $1,657	13%
UnitedHealthcare	$165 - $3,737	13%
Va Ccn - All Plans	$165 - $1,657	13%
Wellcare Mcr Adv - All Plans	$165 - $1,657	13%
Three Rivers - All Plans	$198 - $1,988	16%
Provider Network Of American - All Plans	$248 - $3,583	20%
Partners Hlth Alliance - All Plans	$289 - $3,082	24%
6 Degrees Hlth - All Plans	$298 - $3,082	24%
Medica-All Other Plans	$298 - $3,622	24%
Ambetter / Centene	$303 - $4,308	25%
Midwest Ntwrk Alliance - All Plans	$314 - $3,660	26%
Aetna	$430 - $3,552	35%
Providrs Care/Wppa - All Plans	$449 - $3,468	37%
First Health - All Plans	$1,056 - $3,664	86%
Molina Mcaid - All Plans	$1,110 - $1,695	91%
Cpi Benefit Group-All Plans	$3,468	284%
Chi Health Partners - All Plans	$3,660	299%

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 $1,040.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45380.

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 45380.
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.