CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Gundersen Moundview Hospital and Clinics

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,125
Cash Discount Price: $1,748
vs. Medicare Baseline: 1.74x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Gundersen Moundview Hospital and Clinics is $2,125. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,748. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.74x the Medicare baseline. Located in 402 W Lake St, Friendship, WI.

Cash / Self-Pay

$1,748

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,125

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: $1,748 (143%)

Insurance Median: $2,125 (174%)

Cash: $1,748 (143% of Medicare)

Ins. Median: $2,125 (174% 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
Amerigroup	$430	35%
Blue Cross Blue Shield	$1,175 - $6,427	96%
Health Partners	$1,175 - $3,761	96%
Security Health Plan	$1,175 - $1,959	96%
Ucare	$1,175 - $3,407	96%
Quartz	$1,392 - $2,321	114%
Wps	$1,970 - $3,283	161%
Wps - Arise	$1,970 - $3,283	161%
Dean Health Plan	$2,031 - $3,386	166%
Aspirus Arise Health	$2,121 - $3,535	173%
Humana	$2,172 - $3,620	178%
Multiplan/Healtheos	$2,248 - $4,089	184%
Coventry Health Care	$2,427 - $4,046	199%
UnitedHealthcare	$2,781	227%
Iowa Total Care	$3,081	252%
Managed Health Service	$3,081	252%
Alliance	$3,407 - $4,046	279%

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 $1,748.
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 Gundersen Moundview Hospital and Clinics 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.