CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Valley West Community Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,016
Cash Discount Price: $3,409
vs. Medicare Baseline: 2.12x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Valley West Community Hospital is $2,016. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,409. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.12x the Medicare baseline. Located in 11 East Pleasant Avenue, Sandwich, IL.

Cash / Self-Pay

$3,409

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,016

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: $3,409 (359%)

Insurance Median: $2,016 (212%)

Cash: $3,409 (359% of Medicare)

Ins. Median: $2,016 (212% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 212% of the Medicare baseline (a markup of 112%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Cross Blue Shield	$271 - $2,947	29%
Cigna	$271 - $1,742	29%
Countycare Il Cook Co [1607]	$271	29%
Family Health Network Hmo [1610]	$271	29%
Medicaid / KanCare	$271	29%
Meridian Health Plan Hmo [1604]	$271	29%
Global Excel [1712]	$685	72%
Humana	$685	72%
Aetna	$916 - $2,500	96%
Health'S Finest Network [126]	$1,623 - $3,066	171%
UnitedHealthcare	$1,811 - $3,607	191%
The Alliance [1703]	$1,960	206%
Choicecare [177]	$2,431	256%
Healthlink [125]	$2,705	285%
Multiplan/Phcs [142]	$3,066 - $3,607	323%
First Health Plan [6034]	$3,607	380%

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 $3,409.
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 Valley West Community 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.