CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Rush University Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,691
Cash Discount Price: $2,460
vs. Medicare Baseline: 2.20x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Rush University Medical Center is $2,691. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,460. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 2.20x the Medicare baseline. Located in 1653 West Congress Parkway, Chicago, IL.

Cash / Self-Pay

$2,460

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,691

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: $2,460 (201%)

Insurance Median: $2,691 (220%)

Cash: $2,460 (201% of Medicare)

Ins. Median: $2,691 (220% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 220% of the Medicare baseline (a markup of 120%). 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	$1,237 - $4,920	101%
County Care Mcaid - All Plans	$1,237	101%
Meridian Mcaid - All Other Plans	$1,237	101%
Molina Mcaid	$1,311	107%
Aetna	$1,321 - $4,920	108%
Molina Fide-Snp	$1,334	109%
Meridian Dnsp	$1,346	110%
Cigna	$1,476 - $4,920	121%
Ambetter / Centene	$1,731	142%
Molina Exch - All Other Plans	$1,744	143%
UnitedHealthcare	$2,785 - $6,642	228%
Devoted Mcr Adv - All Plans	$4,920	402%
Humana	$4,920	402%
Wellcare Mcr Adv - All Plans	$4,920	402%
Zing Hlth Mcr Adv - All Plans	$5,215	427%

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 $2,460.
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 Rush University Medical 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.