CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Pinckneyville Community Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,134
Cash Discount Price: $1,882
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Pinckneyville Community Hospital is $1,134. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,882. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.19x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$1,882

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,134

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: $1,882 (198%)

Insurance Median: $1,134 (119%)

Cash: $1,882 (198% of Medicare)

Ins. Median: $1,134 (119% 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
Umwa Mcr Adv - All Plans	$168 - $1,134	18%
UnitedHealthcare	$168 - $2,513	18%
Wellcare Mcr Adv - All Plans	$168 - $1,134	18%
Aetna	$172 - $5,379	18%
Humana	$182 - $1,134	19%
Cigna	$202 - $2,529	21%
Healthlink Hmo	$217 - $2,406	23%
Healthlink Ppo - All Other Plans	$226 - $2,529	24%
Ambetter / Centene	$419 - $5,379	44%
Blue Cross Blue Shield	$419 - $5,379	44%
Medicaid / KanCare	$419 - $5,379	44%
Phcs Savility	$593 - $2,605	62%
Multiplan - All Plans	$628 - $2,758	66%
Phcs - All Other Plans	$628 - $2,513	66%
Healthlink Work Comp	$2,529	266%

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 $1,882.
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 Pinckneyville Community 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.