CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Beloit Health System

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,259
Cash Discount Price: $730
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Beloit Health System is $1,259. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $730. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.03x the Medicare baseline. Located in 1969 W Hart Rd, Beloit, WI.

Cash / Self-Pay

$730

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,259

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: $730 (60%)

Insurance Median: $1,259 (103%)

Cash: $730 (60% of Medicare)

Ins. Median: $1,259 (103% 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
Aetna	$173 - $2,403	14%
Blue Cross Blue Shield	$173 - $3,636	14%
Dean Health	$173 - $4,948	14%
Independent Care Health Plan	$173 - $1,259	14%
Quartz	$173 - $1,442	14%
UnitedHealthcare	$173 - $3,726	14%
Naphcare	$259 - $1,889	21%
Cook Children'S Health Plan (Cchp)	$431 - $1,259	35%
Humana	$698 - $4,685	57%
The Alliance	$734 - $5,037	60%
Wps	$777	64%
Managed Health Services	$1,259	103%
Molina Healthcare	$1,259	103%
Wellcare	$1,259	103%
Wea Trust	$1,391	114%
Multiplan	$2,023	165%
Health Eos	$2,302	188%
Cigna	$2,403	197%
Hfn	$2,403	197%
Preferred Network Access	$2,403	197%

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 $730.
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 Beloit Health System 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.