CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Stoughton Hospital

Billing Code: 45378 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$721

about 0.8× the $950 Medicare rate · typically $206–$2,855

modeled estimate · not a bill or quote

What this hospital charges insurers

$207

Below the fair price — a good deal

about $514 under the fair price · 0.2× Medicare

Medicare pays $950 Fair price $721 This hospital $207 Cash price $834 Hospital's list price $1,515

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

A typical price — 5 charge more and 3 charge less, among the 9 WI hospitals compared.

Cheapest $153 Priciest $654

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Colonoscopy (diagnostic) is about $721 (about 0.8× the $950 Medicare rate). Stoughton Hospital charges insurers about $207, or about $834 in cash — below the fair price — a good deal. Located in Stoughton, 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	$153 - $1,212	16%
Blue Cross Blue Shieldmajor	$530	56%
Aetnamajor	$153 - $1,182	16%
Cignamajor	$1,212	128%
Humanamajor	$207 - $1,364	22%
Dean Health Plan	$153 - $217	16%
GEHA	$1,137	120%
Health Net	$130	14%
Quartz	$153 - $374	16%
+ 2 smaller / regional plans	$567 - $3,268

Government programs also on file: Medicaid, Military & VA.

Excludes 2 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 834), 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: 45378.

Insurance Before you use insurance

Call your insurance company to confirm Stoughton Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 45378.
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 Stoughton Hospital

Compare: Colonoscopy (diagnostic) at other WI hospitals

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