CMS Price Transparency Data

Colonoscopy with biopsy

Facility: St Nicholas Hospital

Billing Code: 45380 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$2,084

about 1.7× the $1,223 Medicare rate · typically $1,257–$2,930

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,858

Below the fair price — a good deal

about $226 under the fair price · 1.5× Medicare

Medicare pays $1,223 Fair price $2,084 This hospital $1,858 Cash price $2,697 Hospital's list price $4,087

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $166 Priciest $1,858

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a Colonoscopy with biopsy is about $2,084 (about 1.7× the $1,223 Medicare rate). St Nicholas Hospital charges insurers about $1,858, or about $2,697 in cash — below the fair price — a good deal. Located in Sheboygan, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$1,140 - $4,087	93%
Blue Cross Blue Shieldmajor	$422 - $4,087	35%
Aetnamajor	$1,140 - $4,087	93%
Cignamajor	$2,861	234%
Humanamajor	$1,140 - $4,087	93%
Health Net	$4,036	330%
Medica	$1,140	93%
Meridian	$422	35%
Molina	$448 - $2,043	37%
Security Health Plan	$1,151 - $2,609	94%
+ 15 smaller / regional plans	$422 - $4,087

Government programs also on file: Medicare, Medicaid.

Excludes 6 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 2,697), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 45380.

Insurance Before you use insurance

Call your insurance company to confirm St Nicholas Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 45380.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at St Nicholas Hospital

Compare: Colonoscopy with biopsy at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.