CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Marshfield Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,240
Cash Discount Price: $1,248
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Marshfield Medical Center is $1,240. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,248. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.01x the Medicare baseline. Located in 611 St Joseph Ave, Marshfield, WI.

Cash / Self-Pay

$1,248

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,240

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: $1,248 (102%)

Insurance Median: $1,240 (101%)

Cash: $1,248 (102% of Medicare)

Ins. Median: $1,240 (101% 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
Family Health Center (Fhc)	$657	54%
Amish/Mennonite	$723	59%
Sanford Health Plan	$723	59%
The Alliance	$913 - $1,097	75%
Group Health Cooperative Of Eau Claire	$1,077 - $1,209	88%
Besse Forest Products	$1,117	91%
Molina Healthcare Of Wi	$1,117	91%
Rice Lake School District	$1,117	91%
Security Health Plan (Shp)	$1,120 - $2,746	92%
Veteran'S Administration (Va Ccn)	$1,120	92%
Blue Cross Blue Shield	$1,153 - $4,686	94%
Wps Health Insurance	$1,159 - $1,268	95%
Trilogy	$1,183 - $1,261	97%
UnitedHealthcare	$1,196	98%
Medica Of Wi	$1,219 - $1,244	100%
Cigna	$1,235	101%
Healtheos By Multiplan Inc.	$1,235 - $1,248	101%
Corvel	$1,248	102%
First Health	$1,248	102%
Health Partners	$1,248	102%
Three Rivers Provider Network (Trpn)	$1,248	102%
Coventry	$1,261	103%
Health Smart	$1,261	103%
Rising Medical Work Comp	$1,275	104%

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 $1,248.
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 Marshfield Medical Center 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.