CMS Price Transparency Data

Colonoscopy with biopsy

Facility: HSHS St Clare Memorial Hospital

Billing Code: 45380 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$965

about 0.8× the $1,223 Medicare rate · typically $598–$2,237

modeled estimate · not a bill or quote

What this hospital charges insurers

$826

Below the fair price — a good deal

about $139 under the fair price · 0.7× Medicare

Medicare pays $1,223 Fair price $965 This hospital $826 Cash price $1,472 Hospital's list price $2,231

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 $826

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 $965 (about 0.8× the $1,223 Medicare rate). HSHS St Clare Memorial Hospital charges insurers about $826, or about $1,472 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	$191	16%
Blue Cross Blue Shieldmajor	$191 - $1,600	16%
Aetnamajor	$191 - $2,231	16%
Cignamajor	$1,394	114%
Humanamajor	$191 - $1,896	16%
Health Net	$1,339	110%
Meridian	$1,600	131%
Molina	$191 - $1,696	16%
Security Health Plan	$193 - $1,424	16%
+ 16 smaller / regional plans	$1,084 - $2,231

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 1,472), 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 HSHS St Clare Memorial Hospital 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 HSHS St Clare Memorial Hospital

Compare: Colonoscopy with biopsy at other WI hospitals

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