CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Hamilton Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $363
Cash Discount Price: $697
vs. Medicare Baseline: 0.38x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Hamilton Memorial Hospital is $363. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $697. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.38x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$697

Average discount available for prompt cash payment at this facility.

Insurance Median

$363

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: $697 (73%)

Insurance Median: $363 (38%)

Cash: $697 (73% of Medicare)

Ins. Median: $363 (38% 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
Aetna	$174 - $363	18%
Blue Cross Blue Shield	$174 - $363	18%
Medicaid / KanCare	$174 - $363	18%
Meridian Health	$174	18%
Health Alliance	$363	38%
Medicare (plans)	$363	38%
UnitedHealthcare	$363	38%
Wellcare	$363	38%
Alliance Coal	$382	40%
Hfn, Inc	$619 - $697	65%
Three Rivers Provider	$697	73%
Hope Trust	$727	77%
Multiplan	$727	77%
Stratose	$735	77%

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 $697.
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 Hamilton Memorial 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.