CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Fort Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,136
Cash Discount Price: $1,404
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Fort Memorial Hospital is $1,136. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,404. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.93x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$1,404

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,136

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: $1,404 (115%)

Insurance Median: $1,136 (93%)

Cash: $1,404 (115% of Medicare)

Ins. Median: $1,136 (93% 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
Molina	$194 - $1,136	16%
UnitedHealthcare	$242 - $1,136	20%
Blue Cross Blue Shield	$413 - $3,138	34%
Dean Health Plan	$413 - $5,393	34%
Medicaid / KanCare	$413	34%
Quartz	$413 - $1,918	34%
Managed Health Services	$450	37%
Fort Care	$608	50%
Group Health Cooperative	$657 - $2,808	54%
Humana	$1,136 - $8,014	93%
Medicare (plans)	$1,136	93%
Veteran Evaluation Services	$1,366	112%
Aetna	$1,750 - $3,255	143%
Centivo	$2,622 - $2,731	214%
Alliance	$3,115	255%
Mercycare	$3,231	264%
Trilogy	$3,817	312%
Cigna	$4,124	337%

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 $1,404.
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 Fort Memorial Hospital 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.