CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Thedacare Regional Medical Center - Appleton Inc

Billing Code: 45380 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$1,148

about 0.9× the $1,223 Medicare rate · typically $284–$2,399

modeled estimate · not a bill or quote

What this hospital charges insurers

$2,273

Well above the fair price

about $1,125 over the fair price · 1.9× Medicare

Medicare pays $1,223 Fair price $1,148 This hospital $2,273 Cash price $1,958 Hospital's list price $3,496

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 $2,273

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 $1,148 (about 0.9× the $1,223 Medicare rate). Thedacare Regional Medical Center - Appleton Inc charges insurers about $2,273, or about $1,958 in cash — well above the fair price. Located in Appleton, WI.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $1,148. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

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	$432 - $3,015	35%
Blue Cross Blue Shieldmajor	$1,111 - $2,971	91%
Aetnamajor	$2,790 - $3,249	228%
Cignamajor	$2,535 - $2,927	207%
Humanamajor	$432 - $1,111	35%
HealthPartners	$2,683	219%
Quartz	$2,239	183%
+ 1 smaller / regional plan	$2,209 - $2,307

Government programs also on file: Medicare, Medicaid.

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 1,958), 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 Thedacare Regional Medical Center - Appleton Inc 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 Thedacare Regional Medical Center - Appleton Inc

Compare: Colonoscopy with biopsy at other WI hospitals

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