CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: St Alexius Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $979
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at St Alexius Medical Center is $979. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.03x the Medicare baseline. Located in 1555 N Barrington Rd, Hoffman Estates, IL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$979

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%)

Insurance Median: $979 (103%)

Ins. Median: $979 (103% 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.

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
Aarp	$903	95%
UnitedHealthcare	$903 - $960	95%
Aetna	$950 - $998	100%
Blue Cross Blue Shield	$950 - $1,682	100%
Covid-19 Uninsured	$950	100%
Humana	$950	100%
Medicare (plans)	$950 - $979	100%
Molina Healthcare Of Illinois	$979	103%
Bright Health	$1,188	125%
Smarthealth	$1,331	140%
Actin Care	$1,473	155%
Ambetter / Centene	$1,540	162%

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 $X.
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 St Alexius Medical Center 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.