CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Black River Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $591
Cash Discount Price: $2,752
vs. Medicare Baseline: 0.48x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Black River Memorial Hospital is $591. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,752. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.48x the Medicare baseline. Located in 711 W Adams St, Black River Falls, WI.

Cash / Self-Pay

$2,752

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: $2,752 (225%)

Insurance Median: $591 (48%)

Cash: $2,752 (225% 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
Humana	$180 - $2,844	15%
UnitedHealthcare	$180 - $2,966	15%
Blue Cross Blue Shield	$225 - $591	18%
My Choice Wisconsin, Inc.	$225 - $591	18%
Quartz Health Solutions, Inc	$225 - $2,783	18%
Security Health Plan	$225 - $2,561	18%
The Alliance	$225 - $2,599	18%
Group Health Cooperative Of Eau Claire	$373 - $2,966	31%
Multiplan	$676 - $2,966	55%
Corvel	$1,865	153%
Triology Health Solutions	$2,752 - $2,905	225%
Medica	$2,856	234%
Association Benefits Solution	$2,905	238%
Family Health Center Of Marshfield	$2,905	238%
First Health Group Corporation	$2,905	238%
Provider Network Of America	$2,905	238%
Cigna	$2,966	243%
Cofinity	$2,966	243%
Coventry Health Care	$2,966	243%
Custom Benefit Administrators	$2,966	243%
Healthpartners, Inc.	$2,966	243%
Wisconsin Physicians Service Insurance Corp	$2,966	243%
Chorus	$2,997	245%

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 $2,752.
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 Black River 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.