CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Monroe Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,444
Cash Discount Price: $1,259
vs. Medicare Baseline: 2.00x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Monroe Hospital is $2,444. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,259. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 2.00x the Medicare baseline. Located in 4011 S Monroe Medical Park Blvd, Bloomington, IN.

Cash / Self-Pay

$1,259

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,444

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: $1,259 (103%)

Insurance Median: $2,444 (200%)

Cash: $1,259 (103% of Medicare)

Ins. Median: $2,444 (200% 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	$1,260	103%
Blue Cross Blue Shield	$1,260 - $2,495	103%
Care Source	$1,260 - $2,495	103%
Medicare (plans)	$1,260	103%
Tricare	$1,260	103%
UnitedHealthcare	$1,260 - $2,495	103%
Usa Senior Care Network	$1,260	103%
Worthington Christian Fellowship	$1,260	103%
Monroe Medical Group And Managed Health Services	$1,285 - $2,495	105%
Provider Partners Health Plan	$1,386	113%
Employer Direct Healthcare	$1,764	144%
Corvel Workers Compensation	$2,192	179%
Zelis Healthcare Fka Stratose	$2,394	196%
Americas Choice Provider Network Acpn	$2,444	200%
Multiplan	$2,444	200%
Prime Health Services	$2,444	200%
Three Rivers	$2,444	200%
Encore Health Network Workers Compensation	$2,469	202%
Provider Select	$2,494	204%
Medicaid / KanCare	$2,495	204%
Provider Network Of America	$2,495	204%
Workers Compensation	$2,495	204%

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 $1,259.
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 Monroe 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.