CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Unitypoint Health - Meriter

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $424
Cash Discount Price: $970
vs. Medicare Baseline: 0.45x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Unitypoint Health - Meriter is $424. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $970. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.45x the Medicare baseline. Located in 202 S Park St, Madison, WI.

Cash / Self-Pay

$970

Average discount available for prompt cash payment at this facility.

Insurance Median

$424

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: $970 (102%)

Insurance Median: $424 (45%)

Cash: $970 (102% of Medicare)

Ins. Median: $424 (45% 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
Aspirus	$83 - $881	9%
Blue Cross Blue Shield	$83 - $3,937	9%
Illinicare	$83 - $881	9%
Prevea 360	$83 - $1,716	9%
UnitedHealthcare	$83 - $5,169	9%
Humana	$87 - $881	9%
Meridiancare	$87 - $881	9%
Health Partners Open Network	$167 - $405	18%
Cigna	$226 - $565	24%
Security Health Plan	$242 - $606	25%
Medical Associates Health Plan	$275 - $549	29%
Wellmark Uph Self-Funded	$277 - $3,937	29%
Mercy Care	$282 - $707	30%

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 $970.
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 Unitypoint Health - Meriter 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.