Colonoscopy with biopsy
Facility: Oakleaf Surgical Hospital
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,185
- 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 $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.
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 | $1,185 - $5,342 | 97% |
| Dean Health Plan | $1,185 | 97% |
| Group Health Cooperative Of Eau Claire | $1,185 | 97% |
| Healthpartners | $1,185 | 97% |
| Humana | $1,185 | 97% |
| Medica | $1,185 | 97% |
| Quartz Health Solutions | $1,185 | 97% |
| Security Health Plan Of Wi | $1,185 - $2,780 | 97% |
| Ucare Wi | $1,185 | 97% |
| UnitedHealthcare | $1,185 | 97% |
| Alliance | $1,700 | 139% |
Consumer Guidance & Cost Commentary
For a Colonoscopy with biopsy at Oakleaf Surgical Hospital in Altoona, WI, the cash median rate is $2,829, which is lower than the facility's gross charge of $3,143. While the facility is owned by physicians and rated as an Acute Care Hospital, the cash price is notably higher than the state average of $413 for the median paid amount. Patients with high-deductible plans may find the cash price more affordable if their insurance negotiated rate exceeds $2,829, though the data indicates most payers have negotiated rates starting at $1,185, which is significantly lower than the cash option.
The facility's negotiated rates vary widely among the 11 participating payers, ranging from a low of $1,185 to a high of $5,342, with most plans settling at the $1,185 mark. This variation highlights the importance of checking specific plan details, as some carriers like Security Health Plan Of Wi offer rates up to $2,780, while others such as Dean Health Plan and Humana maintain a consistent $1,185 rate. To maximize savings, patients should inquire about self-pay or prompt-pay discounts before scheduling, as these upfront payments can bypass the administrative costs associated with insurance claims processing. Additionally, if a patient receives a large bill after insurance submission, they should request an itemized audit to verify all charges and codes rather than accepting a summary invoice.