CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Shirley Ryan Abilitylab

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,813
Cash Discount Price: $2,164
vs. Medicare Baseline: 2.96x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Shirley Ryan Abilitylab is $2,813. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,164. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.96x the Medicare baseline. Located in 355 E Erie St, Chicago, IL.

Cash / Self-Pay

$2,164

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,813

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: $2,164 (228%)

Insurance Median: $2,813 (296%)

Cash: $2,164 (228% of Medicare)

Ins. Median: $2,813 (296% 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 296% of the Medicare baseline (a markup of 196%). 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
Uic Physician Group-Campuscare	$1,804	190%
Personalcare Insurance Of Il/Firsthealth Grp Corp/Coventryhealth And Life Insurance Co	$1,919 - $3,066	202%
State Of Illinois	$1,919	202%
Affordable Health Care Concepts	$2,168	228%
University Of Chicago Practice Plan	$2,345	247%
Health Care Services Corporation Dba Managed Care Network Preferred	$2,456	258%
Gallagher Benefit Administrators	$2,705	285%
Unicare Life And Health Insurance	$2,813	296%
Private Healthcare Systems	$2,886	304%
Resurrection Health Care Preferred	$2,886	304%
Uic Physician Group	$2,922	308%
Cofinity Aka Ppom	$3,066	323%
Health Payors Organization	$3,066	323%
Healthnetwork	$3,174	334%
Hfn	$3,246	342%

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 $2,164.
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 Shirley Ryan Abilitylab 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.