CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Mc Donough District Hospital

Billing Code: 45380 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$334

about 0.3× the $1,223 Medicare rate · typically $190–$807

modeled estimate · not a bill or quote

What this hospital charges insurers

$395

Above the fair price

about $61 over the fair price · 0.3× Medicare

Medicare pays $1,223 Fair price $334 This hospital $395 Cash price $1,426 Hospital's list price $2,376

How we calculate the fair BaseRate →

How this hospital compares to other IL hospitals

Highest price of the 9 IL hospitals we have prices for — worth calling around.

Cheapest $181 Priciest $395

Black dot = this hospital, among the 9 IL hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Colonoscopy with biopsy is about $334 (about 0.3× the $1,223 Medicare rate). Mc Donough District Hospital charges insurers about $395, or about $1,426 in cash — above the fair price. Located in Macomb, IL.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $334. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Humana CignaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$178 - $2,138	15%
Blue Cross Blue Shieldmajor	$1,237 - $2,376	101%
Aetnamajor	$193 - $2,376	16%
Humanamajor	$193 - $2,138	16%
HealthLink	$2,138 - $2,233	175%
Meridian	$193 - $1,316	16%
Molina	$193 - $2,376	16%
+ 9 smaller / regional plans	$116 - $2,376

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 1,426), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 45380.

Insurance Before you use insurance

Call your insurance company to confirm Mc Donough District Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 45380.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Mc Donough District Hospital

Compare: Colonoscopy with biopsy at other IL hospitals

Insurance negotiated median for the same procedure, sorted lowest first.