CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Northwestern Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,188
Cash Discount Price: $3,431
vs. Medicare Baseline: 2.30x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Northwestern Memorial Hospital is $2,188. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,431. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.30x the Medicare baseline. Located in 251 E Huron St, Chicago, IL.

Cash / Self-Pay

$3,431

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,188

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$950.1

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $950.1 (100%)

Cash / Self-Pay: $3,431 (361%)

Insurance Median: $2,188 (230%)

Cash: $3,431 (361% of Medicare)

Ins. Median: $2,188 (230% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $950.1 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 230% of the Medicare baseline (a markup of 130%). 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
Cigna	$675 - $3,607	71%
Aetna	$700 - $3,607	74%
Curaechoice [6100]	$844 - $959	89%
Imagine Health [6032]	$974	103%
Humana	$1,443 - $1,804	152%
Blue Cross Blue Shield	$1,623 - $3,607	171%
Healthlink [125]	$1,804 - $3,607	190%
Global Medical Management Inc [6090]	$2,092	220%
Health'S Finest Network [126]	$2,345 - $3,066	247%
UnitedHealthcare	$2,432 - $3,607	256%
Medpartners [6038]	$2,525	266%
First Health Plan [6034]	$3,607	380%
Galaxy Health Network [220]	$3,607	380%
Multiplan/Phcs [142]	$3,607	380%

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 $3,431.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Northwestern Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45378.
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.