CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: UW Health

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $475
Cash Discount Price: $254
vs. Medicare Baseline: 0.50x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at UW Health is $475. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $254. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.50x the Medicare baseline. Located in 1401 East State Street, Rockford, IL.

Cash / Self-Pay

$254

Average discount available for prompt cash payment at this facility.

Insurance Median

$475

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: $254 (27%)

Insurance Median: $475 (50%)

Cash: $254 (27% of Medicare)

Ins. Median: $475 (50% 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	$168 - $2,662	18%
Blue Cross Blue Shield	$168 - $1,824	18%
Humana	$168 - $950	18%
Medicare (plans)	$168 - $1,045	18%
Mychoice Wi Medical Adv	$168 - $950	18%
UnitedHealthcare	$168 - $2,834	18%
Medicaid / KanCare	$179	19%
Cigna	$325 - $2,943	34%
Quartz Fully Insured	$355 - $1,279	37%
Alliance Premier Network	$374 - $2,013	39%
Quartz Aso	$401 - $2,014	42%
The Alliance	$402 - $2,591	42%
Ecoh	$428 - $2,903	45%
Hfn	$428 - $2,903	45%
Wps	$795	84%
Beloit Healt System	$922 - $3,327	97%
Workers Comp	$1,043	110%
Mercy Care	$1,113	117%
Wps Ppo	$2,851	300%
Mercycare	$3,442	362%
First Health/Coventry	$3,626	382%
Health Payment Systems	$4,303	453%
Healthsmart	$4,303	453%
Sheboygan Employers Health Network	$4,590	483%
Multiplan	$5,129	540%

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 $254.
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 UW Health 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.