CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Shirley Ryan Abilitylab

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $4,562
Cash Discount Price: $3,509
vs. Medicare Baseline: 3.73x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Shirley Ryan Abilitylab is $4,562. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,509. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 3.73x the Medicare baseline. Located in 355 E Erie St, Chicago, IL.

Cash / Self-Pay

$3,509

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,562

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: $3,509 (287%)

Insurance Median: $4,562 (373%)

Cash: $3,509 (287% of Medicare)

Ins. Median: $4,562 (373% 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 373% of the Medicare baseline (a markup of 273%). 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	$2,924	239%
Personalcare Insurance Of Il/Firsthealth Grp Corp/Coventryhealth And Life Insurance Co	$3,112 - $4,972	255%
State Of Illinois	$3,112	255%
Affordable Health Care Concepts	$3,515	288%
University Of Chicago Practice Plan	$3,802	311%
Health Care Services Corporation Dba Managed Care Network Preferred	$3,983	326%
Gallagher Benefit Administrators	$4,387	359%
Unicare Life And Health Insurance	$4,562	373%
Private Healthcare Systems	$4,679	383%
Resurrection Health Care Preferred	$4,679	383%
Uic Physician Group	$4,738	388%
Cofinity Aka Ppom	$4,972	407%
Health Payors Organization	$4,972	407%
Healthnetwork	$5,147	421%
Hfn	$5,264	431%

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 $3,509.
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 Shirley Ryan Abilitylab 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.