CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Monroe Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,860
Cash Discount Price: $979
vs. Medicare Baseline: 1.96x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Monroe Hospital is $1,860. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $979. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.96x the Medicare baseline. Located in 4011 S Monroe Medical Park Blvd, Bloomington, IN.

Cash / Self-Pay

$979

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,860

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: $979 (103%)

Insurance Median: $1,860 (196%)

Cash: $979 (103% of Medicare)

Ins. Median: $1,860 (196% 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.

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	$979	103%
Blue Cross Blue Shield	$979 - $2,406	103%
Care Source	$979 - $2,274	103%
Medicare (plans)	$979	103%
Tricare	$979	103%
UnitedHealthcare	$979 - $2,274	103%
Usa Senior Care Network	$979	103%
Worthington Christian Fellowship	$979	103%
Monroe Medical Group And Managed Health Services	$999 - $2,274	105%
Provider Partners Health Plan	$1,077	113%
Employer Direct Healthcare	$1,371	144%
Corvel Workers Compensation	$1,704	179%
Zelis Healthcare Fka Stratose	$1,860	196%
Americas Choice Provider Network Acpn	$1,899	200%
Multiplan	$1,899	200%
Prime Health Services	$1,899	200%
Three Rivers	$1,899	200%
Encore Health Network Workers Compensation	$1,919	202%
Provider Select	$1,939	204%
Provider Network Of America	$1,958	206%
Workers Compensation	$1,958	206%
Medicaid / KanCare	$2,274	239%

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 $979.
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 Monroe 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.