CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Carle Eureka Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,306
Cash Discount Price: $2,645
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Carle Eureka Hospital is $1,306. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,645. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.07x the Medicare baseline. Located in 101 S Major St, Eureka, IL.

Cash / Self-Pay

$2,645

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,306

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: $2,645 (216%)

Insurance Median: $1,306 (107%)

Cash: $2,645 (216% of Medicare)

Ins. Median: $1,306 (107% 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
Cigna	$82	7%
Humana	$194 - $1,427	16%
Aetna	$200 - $2,097	16%
Meridian	$212 - $1,523	17%
Molina	$423 - $1,523	35%
UnitedHealthcare	$953 - $1,957	78%
Community Partners Health Plan (Cphp)	$1,270 - $1,903	104%
Wellcare	$1,282	105%
Healthlink	$1,376 - $2,062	113%
Blue Cross Blue Shield	$1,418 - $2,664	116%
Multiplan/Phcs	$1,588 - $2,379	130%

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 $2,645.
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 Carle Eureka 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.