CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Black River Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,280
Cash Discount Price: $3,364
vs. Medicare Baseline: 2.40x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Black River Memorial Hospital is $2,280. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,364. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.40x the Medicare baseline. Located in 711 W Adams St, Black River Falls, WI.

Cash / Self-Pay

$3,364

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,280

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$950.1

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $950.1 (100%)

Cash / Self-Pay: $3,364 (354%)

Insurance Median: $2,280 (240%)

Cash: $3,364 (354% of Medicare)

Ins. Median: $2,280 (240% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $950.1 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 240% of the Medicare baseline (a markup of 140%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Humana	$165 - $3,476	17%
UnitedHealthcare	$165 - $3,525	17%
Blue Cross Blue Shield	$168 - $3,289	18%
My Choice Wisconsin, Inc.	$168 - $1,906	18%
Quartz Health Solutions, Inc	$168 - $3,402	18%
Security Health Plan	$168 - $3,491	18%
The Alliance	$168 - $3,588	18%
Group Health Cooperative Of Eau Claire	$310 - $3,626	33%
Multiplan	$503 - $3,701	53%
Corvel	$1,495 - $2,280	157%
Triology Health Solutions	$2,206 - $3,551	232%
Medica	$2,289 - $3,491	241%
Association Benefits Solution	$2,328 - $3,551	245%
Family Health Center Of Marshfield	$2,328 - $3,551	245%
First Health Group Corporation	$2,328 - $3,551	245%
Provider Network Of America	$2,328 - $3,551	245%
Cigna	$2,377 - $3,626	250%
Cofinity	$2,377 - $3,626	250%
Coventry Health Care	$2,377 - $3,626	250%
Custom Benefit Administrators	$2,377 - $3,626	250%
Healthpartners, Inc.	$2,377 - $3,626	250%
Wisconsin Physicians Service Insurance Corp	$2,377 - $3,626	250%
Chorus	$2,402 - $3,663	253%

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 $3,364.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Black River Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45378.
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.