CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Sarah Bush Lincoln Health Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $377
Cash Discount Price: $1,734
vs. Medicare Baseline: 0.31x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Sarah Bush Lincoln Health Center is $377. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,734. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.31x the Medicare baseline. Located in 1000 Health Center Drive P O Box 372, Mattoon, IL.

Cash / Self-Pay

$1,734

Average discount available for prompt cash payment at this facility.

Insurance Median

$377

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: $1,734 (142%)

Insurance Median: $377 (31%)

Cash: $1,734 (142% of Medicare)

Ins. Median: $377 (31% 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
Aetna	$181 - $1,561	15%
Bc Comm Mmai	$181	15%
Beacon Health Options Behav-All Plans	$181	15%
Hlth Alliance Mcr Adv	$181	15%
Humana	$181 - $185	15%
Meridian Mcaid	$181	15%
Meridian Mmai-All Other Plans	$181	15%
Molina Mmai-All Other Plans	$181	15%
Tricare	$181	15%
UnitedHealthcare	$181 - $1,439	15%
Va Ccn-All Plans	$181	15%
Wellcare Med Adv-All Plans	$181	15%
Bc Med Adv Ppo/Hmo	$187	15%
First Health-All Plans	$269	22%
Multiplan-All Plans	$336	27%
Blue Cross Blue Shield	$418 - $895	34%
Plain Church Mg-All Plans	$694	57%
Mennonite-All Plans	$780	64%
Eiu Athlete-All Other Plans	$1,214	99%
Healthscope-All Plans	$1,283	105%
Rural King-All Plans	$1,283	105%
Hope Trust-All Plans	$1,387	113%
Eiu Student	$1,422	116%
Allied National-All Plans	$1,457	119%
Companion Life-All Plans	$1,457	119%
Innovative Hlthware-All Plans	$1,474	121%
Healthlink Hmo	$1,491	122%
Healthlink Ppo - All Other Plans	$1,491	122%
Cigna	$1,561	128%
Consociate-All Plans	$1,561	128%
Cphp-All Plans	$1,561	128%
Beech Street-All Plans	$1,595	130%
Hfn-All Plans	$1,595	130%

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 $1,734.
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 Sarah Bush Lincoln Health 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.