CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Pinckneyville Community Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,632
Cash Discount Price: $2,582
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Pinckneyville Community Hospital is $1,632. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,582. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.33x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$2,582

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,632

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: $2,582 (211%)

Insurance Median: $1,632 (133%)

Cash: $2,582 (211% of Medicare)

Ins. Median: $1,632 (133% 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
Umwa Mcr Adv - All Plans	$181 - $1,632	15%
UnitedHealthcare	$181 - $3,616	15%
Wellcare Mcr Adv - All Plans	$181 - $1,632	15%
Aetna	$185 - $5,379	15%
Humana	$198 - $1,632	16%
Cigna	$218 - $3,638	18%
Healthlink Hmo	$235 - $3,462	19%
Healthlink Ppo - All Other Plans	$245 - $3,638	20%
Phcs Savility	$641 - $3,748	52%
Multiplan - All Plans	$679 - $3,969	56%
Phcs - All Other Plans	$679 - $3,616	56%
Blue Cross Blue Shield	$872 - $5,379	71%
Healthlink Work Comp	$3,638	298%
Ambetter / Centene	$5,379	440%
Medicaid / KanCare	$5,379	440%

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 $2,582.
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 Pinckneyville 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.