CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Tomah Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $591
Cash Discount Price: $1,021
vs. Medicare Baseline: 0.48x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Tomah Memorial Hospital is $591. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,021. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.48x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$1,021

Average discount available for prompt cash payment at this facility.

Insurance Median

$591

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: $1,021 (84%)

Insurance Median: $591 (48%)

Cash: $1,021 (84% of Medicare)

Ins. Median: $591 (48% 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
UnitedHealthcare	$141 - $751	12%
Blue Cross Blue Shield	$166 - $999	14%
Group Hlth Mcr Adv - All Plans	$166	14%
Independent Care Mcr - All Other Plans	$166	14%
Quartz Mcr Adv	$166	14%
Security Hp Mcr Adv	$166	14%
Va Ccn - All Plans	$166	14%
Aetna	$191 - $1,509	16%
Independent Care Mcaid	$591	48%
Managed Hlth Mcaid - All Plans	$591	48%
Quartz Mcaid	$591	48%
Security Hp Mcaid	$591	48%
The Alliance - All Plans	$705	58%
Security Hp Comm - All Other Plans	$1,509	123%
Quartz Comm - All Other Plans	$1,598	131%
Humana	$1,642	134%
Cigna	$1,722	141%

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 $1,021.
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 Tomah Memorial Hospital 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.