CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Mc Donough District Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,237
Cash Discount Price: $1,426
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Mc Donough District Hospital is $1,237. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,426. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.01x the Medicare baseline. Located in 525 East Grant Street, Macomb, IL.

Cash / Self-Pay

$1,426

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,237

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: $1,426 (117%)

Insurance Median: $1,237 (101%)

Cash: $1,426 (117% of Medicare)

Ins. Median: $1,237 (101% 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
Health Alliance	$116 - $2,115	9%
Hfn	$178 - $2,138	15%
UnitedHealthcare	$178 - $2,138	15%
Aetna	$193 - $2,376	16%
Humana	$193 - $2,138	16%
Medicaid / KanCare	$193 - $2,376	16%
Medicare (plans)	$193 - $1,316	16%
Meridian	$193 - $1,316	16%
Molina	$193 - $2,376	16%
Mutual Medical	$193 - $2,376	16%
Veteran Affairs	$193 - $1,316	16%
Tricare	$1,229	101%
Blue Cross Blue Shield	$1,237 - $2,376	101%
Springfield Health	$1,948	159%
Consociate	$2,020	165%
Trilogy	$2,020	165%
Blue Choice	$2,138	175%
Current Health	$2,138	175%
Healthlink	$2,138 - $2,233	175%
Preferred Plan	$2,257	185%

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 $1,426.
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 Mc Donough District Hospital 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.