CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Marshfield Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,459
Cash Discount Price: $1,469
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Marshfield Medical Center is $1,459. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,469. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.54x the Medicare baseline. Located in 611 St Joseph Ave, Marshfield, WI.

Cash / Self-Pay

$1,469

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,459

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: $1,469 (155%)

Insurance Median: $1,459 (154%)

Cash: $1,469 (155% of Medicare)

Ins. Median: $1,459 (154% 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
Family Health Center (Fhc)	$773	81%
Amish/Mennonite	$850	89%
Sanford Health Plan	$850	89%
Security Health Plan (Shp)	$866 - $2,307	91%
Veteran'S Administration (Va Ccn)	$866	91%
Blue Cross Blue Shield	$892 - $3,163	94%
Group Health Cooperative Of Eau Claire	$918 - $1,422	97%
The Alliance	$1,074 - $1,291	113%
Besse Forest Products	$1,314	138%
Molina Healthcare Of Wi	$1,314	138%
Rice Lake School District	$1,314	138%
Wps Health Insurance	$1,364 - $1,492	144%
Trilogy	$1,391 - $1,484	146%
UnitedHealthcare	$1,407	148%
Medica Of Wi	$1,435 - $1,464	151%
Cigna	$1,453	153%
Healtheos By Multiplan Inc.	$1,453 - $1,469	153%
Corvel	$1,469	155%
First Health	$1,469	155%
Health Partners	$1,469	155%
Three Rivers Provider Network (Trpn)	$1,469	155%
Coventry	$1,484	156%
Health Smart	$1,484	156%
Rising Medical Work Comp	$1,500	158%

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 $1,469.
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 Marshfield Medical Center 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.