CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: HSHS St Clare Memorial Hospital

Billing Code: 45378 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$859

about 0.9× the $950 Medicare rate · typically $526–$2,045

modeled estimate · not a bill or quote

What this hospital charges insurers

$673

Below the fair price — a good deal

about $186 under the fair price · 0.7× Medicare

Medicare pays $950 Fair price $859 This hospital $673 Cash price $1,338 Hospital's list price $2,028

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 $153 Priciest $673

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a Colonoscopy (diagnostic) is about $859 (about 0.9× the $950 Medicare rate). HSHS St Clare Memorial Hospital charges insurers about $673, or about $1,338 in cash — below the fair price — a good deal. Located in Oconto Falls, WI.

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	$176	19%
Blue Cross Blue Shieldmajor	$176 - $1,600	19%
Aetnamajor	$176 - $2,028	19%
Cignamajor	$1,268	133%
Humanamajor	$176 - $1,724	19%
Health Net	$1,217	128%
Meridian	$1,600	168%
Molina	$176 - $1,696	19%
Security Health Plan	$178 - $1,294	19%
+ 16 smaller / regional plans	$950 - $2,028

Government programs also on file: Medicaid.

Excludes 6 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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 1,338), 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: 45378.

Insurance Before you use insurance

Call your insurance company to confirm HSHS St Clare Memorial Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 45378.
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 HSHS St Clare Memorial Hospital

Compare: Colonoscopy (diagnostic) at other WI hospitals

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