CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Alton Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,159
Cash Discount Price: $3,417
vs. Medicare Baseline: 2.27x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Alton Memorial Hospital is $2,159. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,417. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.27x the Medicare baseline. Located in One Memorial Drive, Alton, IL.

Cash / Self-Pay

$3,417

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,159

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: $3,417 (360%)

Insurance Median: $2,159 (227%)

Cash: $3,417 (360% of Medicare)

Ins. Median: $2,159 (227% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 227% of the Medicare baseline (a markup of 127%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
UnitedHealthcare	$931 - $4,937	98%
Healthscope Benefits [258]	$976 - $4,937	103%
Aetna	$997 - $4,713	105%
Blue Cross Blue Shield	$997 - $4,374	105%
Humana	$997 - $6,690	105%
Essence Healthcare [221]	$1,026 - $2,118	108%
Cox Health [757]	$1,046 - $2,159	110%
Devoted Health Plan [847]	$1,046 - $2,159	110%
Medica [662]	$1,046 - $2,159	110%
Cox Health Systems Insurance Company [220]	$1,192	125%
Health Alliance [224]	$1,192	125%
Allied Benefits [498]	$1,257 - $4,713	132%
Hope Trust [806]	$1,257	132%
Healthcare Sol Mercy [609]	$1,626	171%
Med-Pay [480]	$1,626	171%
Cigna	$1,693 - $6,771	178%
Medica [661]	$1,734	183%
Phcs [244]	$1,734	183%
Consociate [478]	$1,850 - $4,587	195%
Sarah Bush Lincoln [636]	$1,850 - $4,587	195%
Coresource [497]	$2,281 - $4,713	240%
Fmh Benefit Service Inc [222]	$2,281 - $4,713	240%
Mail Handlers [495]	$2,281 - $4,713	240%
Apwu Health Plan [216]	$2,769 - $6,771	291%
Nalc Health Benefit Plan [242]	$2,769 - $6,771	291%
Priority Health [648]	$2,769 - $6,771	291%

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 $3,417.
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 Alton Memorial Hospital 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.