CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Valley West Community Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $3,270
Cash Discount Price: $8,178
vs. Medicare Baseline: 2.67x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Valley West Community Hospital is $3,270. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,178. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 2.67x the Medicare baseline. Located in 11 East Pleasant Avenue, Sandwich, IL.

Cash / Self-Pay

$8,178

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,270

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: $8,178 (669%)

Insurance Median: $3,270 (267%)

Cash: $8,178 (669% of Medicare)

Ins. Median: $3,270 (267% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 267% of the Medicare baseline (a markup of 167%). 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 - $4,779	22%
Cigna	$271 - $2,825	22%
Countycare Il Cook Co [1607]	$271	22%
Family Health Network Hmo [1610]	$271	22%
Medicaid / KanCare	$271	22%
Meridian Health Plan Hmo [1604]	$271	22%
Global Excel [1712]	$1,111	91%
Humana	$1,111	91%
Aetna	$1,486 - $4,053	122%
Health'S Finest Network [126]	$2,632 - $4,972	215%
UnitedHealthcare	$2,936 - $5,849	240%
The Alliance [1703]	$3,179	260%
Choicecare [177]	$3,942	322%
Healthlink [125]	$4,387	359%
Multiplan/Phcs [142]	$4,972 - $5,849	407%
First Health Plan [6034]	$5,849	478%

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 $8,178.
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 Valley West Community 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.