CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Northwestern Medicine Delnor Community Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $3,685
Cash Discount Price: $8,174
vs. Medicare Baseline: 3.01x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Northwestern Medicine Delnor Community Hospital is $3,685. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,174. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 3.01x the Medicare baseline. Located in 300 Randall Rd, Geneva, IL.

Cash / Self-Pay

$8,174

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,685

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: $8,174 (669%)

Insurance Median: $3,685 (301%)

Cash: $8,174 (669% of Medicare)

Ins. Median: $3,685 (301% 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 301% of the Medicare baseline (a markup of 201%). 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	$872 - $4,078	71%
Aetna	$953 - $1,725	78%
First Health Plan [6034]	$1,568 - $4,036	128%
Cigna	$2,193 - $4,679	179%
UnitedHealthcare	$2,741 - $5,849	224%
Carelon Behavioral Health [159]	$2,924	239%
Health'S Finest Network [126]	$2,924 - $4,972	239%
Healthlink [125]	$3,685	301%
The Alliance [1703]	$3,757	307%
Multiplan/Phcs [142]	$4,387 - $5,849	359%
Compsych [112]	$4,679	383%
Beechstreet [176]	$5,264	431%

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 $8,174.
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 Northwestern Medicine Delnor Community 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.