CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Hammond Henry Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $870
Cash Discount Price: $1,424
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Hammond Henry Hospital is $870. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,424. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.92x the Medicare baseline. Located in 600 N College Avenue, Geneseo, IL.

Cash / Self-Pay

$1,424

Average discount available for prompt cash payment at this facility.

Insurance Median

$870

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: $1,424 (150%)

Insurance Median: $870 (92%)

Cash: $1,424 (150% of Medicare)

Ins. Median: $870 (92% 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
Cigna	$49 - $1,752	5%
Multiplan Phcs Adult	$90 - $1,424	9%
Multiplan Phcs Pediatric	$90 - $1,424	9%
Tricare	$152 - $217	16%
Aetna	$168 - $2,351	18%
Health Alliance Mcare Adv	$168 - $241	18%
Humana	$168 - $1,424	18%
UnitedHealthcare	$168 - $268	18%
Blue Cross Blue Shield	$188 - $2,351	20%
Health Alliance-All Other Plans	$219 - $1,186	23%
Quad City Community Hc-All Plans	$239 - $791	25%
Ambetter / Centene	$253 - $1,107	27%
Multiplan Pponext	$286 - $1,266	30%
Springfield Armory-All Plans	$329 - $1,028	35%
Multiplan-All Other Plans	$337 - $1,345	35%
Wellmark Of Ia-All Plans	$349 - $791	37%
Multiplan Integrated Hp	$1,186	125%
Osf Direct Access Network-All Plans	$1,266	133%
Corvel-All Plans	$1,424	150%
Healthsmart Adult-All Other Plans	$1,424	150%
Healthsmart Pediatric	$1,424	150%
Hfn-All Plans	$1,424	150%
Multiplan Beech Street	$1,424	150%
Usa Mco-All Plans	$1,424	150%
Meridian Health Plan-All Plans	$1,582 - $2,351	167%

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 $1,424.
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 Hammond Henry 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.