CMS Price Transparency Data

Colonoscopy with biopsy

Facility: UW Health

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $928
Cash Discount Price: $907
vs. Medicare Baseline: 0.76x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at UW Health is $928. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $907. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.76x the Medicare baseline. Located in 1401 East State Street, Rockford, IL.

Cash / Self-Pay

$907

Average discount available for prompt cash payment at this facility.

Insurance Median

$928

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: $907 (74%)

Insurance Median: $928 (76%)

Cash: $907 (74% of Medicare)

Ins. Median: $928 (76% 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	$181 - $2,663	15%
Blue Cross Blue Shield	$181 - $1,825	15%
Humana	$181 - $1,223	15%
Medicare (plans)	$181 - $1,345	15%
Mychoice Wi Medical Adv	$181 - $1,223	15%
UnitedHealthcare	$181 - $2,836	15%
Medicaid / KanCare	$194	16%
Cigna	$351 - $2,945	29%
Quartz Fully Insured	$386 - $1,280	32%
Alliance Premier Network	$407 - $2,014	33%
Quartz Aso	$436 - $2,015	36%
The Alliance	$438 - $2,592	36%
Ecoh	$464 - $2,904	38%
Hfn	$464 - $2,904	38%
Wps	$927	76%
Beloit Healt System	$1,075 - $3,329	88%
Workers Comp	$1,170	96%
Mercy Care	$1,298	106%
Wps Ppo	$2,818 - $2,853	230%
Mercycare	$3,402 - $3,444	278%
First Health/Coventry	$3,583 - $3,628	293%
Health Payment Systems	$4,252 - $4,305	348%
Healthsmart	$4,252 - $4,305	348%
Sheboygan Employers Health Network	$4,536 - $4,592	371%
Multiplan	$5,069 - $5,132	415%

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 $907.
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 UW Health 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.