CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Clay County Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $210
Cash Discount Price: $3,890
vs. Medicare Baseline: 0.17x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Clay County Hospital is $210. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,890. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.17x the Medicare baseline. Located in 911 Stacy Burk Dr, Flora, IL.

Cash / Self-Pay

$3,890

Average discount available for prompt cash payment at this facility.

Insurance Median

$210

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: $3,890 (318%)

Insurance Median: $210 (17%)

Cash: $3,890 (318% of Medicare)

Ins. Median: $210 (17% 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.

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	$181 - $233	15%
Ambetter / Centene	$181	15%
Medica(Wellfirst)	$181 - $227	15%
Meridian	$181 - $194	15%
UnitedHealthcare	$181 - $518	15%
Wellcare	$181	15%
Blue Cross Blue Shield	$194 - $849	16%
Molina	$194	16%
Healthlink	$2,528 - $3,112	207%
Cigna	$3,112	255%
Usa Mco	$3,696	302%

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 $3,890.
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 Clay County 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.