CMS Price Transparency Data

Colonoscopy with biopsy

Facility: St Josephs Community Hospital West Bend

Billing Code: 45380 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$1,517

about 1.2× the $1,223 Medicare rate · typically $1,167–$3,536

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,145

Below the fair price — a good deal

about $372 under the fair price · 0.9× Medicare

Medicare pays $1,223 Fair price $1,517 This hospital $1,145

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 $1,145

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 $1,517 (about 1.2× the $1,223 Medicare rate). St Josephs Community Hospital West Bend charges insurers about $1,145 — below the fair price — a good deal. Located in West Bend, WI.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Humana CignaKaiser 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	$1,145 - $6,312	94%
Blue Cross Blue Shieldmajor	$1,145 - $5,470	94%
Aetnamajor	$1,168	96%
Humanamajor	$1,145	94%
Health Net	$6,199	507%
HealthPartners	$1,145	94%
Molina	$1,145	94%
Security Health Plan	$1,145	94%
+ 5 smaller / regional plans	$1,145 - $4,326

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, 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 Josephs Community Hospital West Bend 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 Josephs Community Hospital West Bend

Compare: Colonoscopy with biopsy at other WI hospitals

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