Colonoscopy (diagnostic)
Facility: Oakleaf Surgical Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $921
- Cash Discount Price: $2,829
- vs. Medicare Baseline: 0.97x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $921 - $2,245 | 97% |
| Dean Health Plan | $921 | 97% |
| Group Health Cooperative Of Eau Claire | $921 | 97% |
| Healthpartners | $921 | 97% |
| Humana | $921 | 97% |
| Medica | $921 | 97% |
| Quartz Health Solutions | $921 | 97% |
| Security Health Plan Of Wi | $921 - $2,471 | 97% |
| Ucare Wi | $921 | 97% |
| UnitedHealthcare | $921 | 97% |
| Alliance | $1,700 | 179% |
Consumer Guidance & Cost Commentary
For a diagnostic colonoscopy at Oakleaf Surgical Hospital in Altoona, WI, the cash median price is $2,829, while the facility's gross chargemaster rate is listed at $3,143. Although the cash price is lower than the gross charge, it is notably higher than the median negotiated rate of $921 paid by insurance companies and the median paid rate of $413. This significant difference highlights how negotiated rates often serve as a ceiling to protect in-network members, though patients with high-deductible plans may find the cash price more affordable if their insurance allowed amount exceeds $2,829.
The facility is owned by physicians and operates as an acute care hospital, but no specific facility rating data is available for this location. While the cash price of $2,829 represents a potential savings compared to the gross charge, patients should be aware that commercial insurance contracts can sometimes result in higher out-of-pocket costs due to deductibles or co-pays. To minimize expenses, patients are encouraged to explicitly request "self-pay" or "prompt-pay" discounts at the time of registration, as these upfront payment incentives can reduce the final bill by 20% to 50%. Additionally, if balance billing occurs from out-of-network ancillary services, patients should verify the legality of the charges under the No Surprises Act before making immediate payment.