Colorectal cancer screening (alternative)
Facility: Sarah D Culbertson Memorial Hospital
Billing Code: G0145 (HCPCS)
- CPT Billing Code: G0145
- Insurance Median: $164
- Cash Discount Price: $164
- vs. Medicare Baseline: 6.19x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $26.49 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 619% of the Medicare baseline (a markup of 519%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $54 - $164 | 204% |
| Blue Cross Blue Shield | $54 - $178 | 204% |
| Corvel-All Plans | $54 | 204% |
| Meridian Hp McAid-All Plans | $54 | 204% |
| Molina Healthcare McAid | $54 | 204% |
| Humana | $78 | 294% |
| Molina Mmai-All Other Plans | $78 | 294% |
| UnitedHealthcare | $78 - $164 | 294% |
| Cigna | $134 | 506% |
| Beech Street-All Plans | $164 | 619% |
| Encompass-All Plans | $164 | 619% |
| Health Dynamics-All Plans | $164 | 619% |
| Healthlink-All Plans | $164 | 619% |
| Hfn EPO | $164 | 619% |
| Hfn PPO Ip/Op Only-All Other Plans | $164 | 619% |
| Multiplan/Phcs-All Plans | $164 | 619% |
| Preferred Medical Claims Solution-All Plans | $164 | 619% |
| Three Rivers Provider Network-All Plans | $164 | 619% |
| Wexford Ip/Op Only-All Plans | $164 | 619% |
| Healthsmart-All Plans | $173 | 653% |
Consumer Guidance & Cost Commentary
For this procedure, the cash price is $164, which is lower than the gross charge of $182 and significantly lower than the Medicare benchmark rate of $26.49. While the facility's cash rate is the lowest amount available in this dataset, it is important to note that commercial insurance negotiated rates vary widely among payers, ranging from a low of $54 to a high of $178. Because many of these negotiated rates exceed the cash price, patients with high-deductible plans or those who have not yet met their deductible may find that paying the cash rate of $164 upfront is the most cost-effective option.
The facility, Sarah D Culbertson Memorial Hospital, is a Critical Access Hospital in Rushville, IL, and the cash rate of $164 aligns exactly with the median negotiated rate and the median paid amount. Several commercial payers, including Aetna, Blue Cross Blue Shield, and UnitedHealthcare, have negotiated rates that reach $164 or higher, confirming that the cash price is competitive relative to the insurance contracts in place. Patients should verify their specific plan details, as some carriers like Humana and Molina Mmai have fixed negotiated rates of $78, while others such as Beech Street and Encompass maintain a fixed rate of $164. To ensure the lowest possible cost, individuals are encouraged to ask the hospital directly about self-pay discounts or prompt-pay incentives before scheduling the service.