CMS Price Transparency Data

Colonoscopy with biopsy

Facility: St Marys Hospital Superior

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,232
Cash Discount Price: $2,264
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at St Marys Hospital Superior is $1,232. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,264. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.01x the Medicare baseline. Located in 3500 Tower Ave, Superior, WI.

Cash / Self-Pay

$2,264

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,232

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: $2,264 (185%)

Insurance Median: $1,232 (101%)

Cash: $2,264 (185% of Medicare)

Ins. Median: $1,232 (101% 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
Advocare/Security Health	$980	80%
Blue Cross Blue Shield	$980 - $2,461	80%
Freedom Blue Ppo	$980	80%
Healthpartners Care Msho / Mcr Adv	$980	80%
Imcare Msho Pcc Prime	$980	80%
Imcare Msho Ref Req	$980	80%
Medica Advantage Solutions	$980	80%
Medica Msho/Dual Solutions	$980	80%
Medica Prime Solution Group	$980	80%
Medica Uplan	$980	80%
Medicare (plans)	$980	80%
Nd Va Administration	$980	80%
Platinum Blue/Vantage Blue	$980	80%
Primewest Msho	$980	80%
Secure Blue Msho	$980	80%
Ubh Cost Plan	$980	80%
Ubh Msho	$980	80%
Ucare Msho	$980	80%
UnitedHealthcare	$980 - $2,773	80%
Primewest	$1,138	93%
Blue Plus Pmap Pcc Prime	$1,176	96%
Itasca Med Care	$1,179	96%
Healthpartners Care Pmap	$1,232	101%
Medica Access	$1,232	101%
Sanford Healthplan	$1,314	107%
Ucare	$2,016	165%
Healthpartners	$2,071 - $2,390	169%
Medica	$2,154 - $2,393	176%
Wea	$2,206 - $2,359	180%
Security Health	$2,359	193%
America'S Ppo	$2,375	194%
Cigna	$2,390	195%
Healthpartners Pcc Prime	$2,390	195%
Medica Choice	$2,463	201%
Wps	$2,574	211%
Aetna	$2,604	213%
Healtheos	$2,635	216%

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 $2,264.
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 St Marys Hospital Superior 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.