CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Palos Community Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,705
Cash Discount Price: $3,318
vs. Medicare Baseline: 2.85x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Palos Community Hospital is $2,705. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,318. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.85x the Medicare baseline. Located in 12251 South 80Th Avenue, Palos Heights, IL.

Cash / Self-Pay

$3,318

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,705

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: $3,318 (349%)

Insurance Median: $2,705 (285%)

Cash: $3,318 (349% of Medicare)

Ins. Median: $2,705 (285% 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 285% of the Medicare baseline (a markup of 185%). 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
Blue Cross Blue Shield	$577 - $3,607	61%
Cigna	$675 - $3,607	71%
Aetna	$776 - $3,607	82%
First Health Plan [6034]	$1,522 - $2,705	160%
Carelon Behavioral Health [159]	$1,804	190%
Healthlink [125]	$1,804 - $3,607	190%
Magellan Behavioral Hlth [136]	$2,164	228%
The Alliance [1703]	$2,317	244%
Multiplan/Phcs [142]	$2,525 - $3,607	266%
Compsych [112]	$2,705	285%
UnitedHealthcare	$2,741 - $3,607	288%
Beechstreet [176]	$2,886	304%
Health'S Finest Network [126]	$3,066	323%
Galaxy Health Network [220]	$3,607	380%
Global Excel [1712]	$3,607	380%
Health Alliance [181]	$3,607	380%

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 $3,318.
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 Palos Community 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.