CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Stoughton Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $375
Cash Discount Price: $834
vs. Medicare Baseline: 0.39x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Stoughton Hospital is $375. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $834. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.39x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$834

Average discount available for prompt cash payment at this facility.

Insurance Median

$375

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: $834 (88%)

Insurance Median: $375 (39%)

Cash: $834 (88% of Medicare)

Ins. Median: $375 (39% 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.

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
Healthnet Mcr Adv - All Plans	$130	14%
Tricare	$130	14%
Aetna	$153 - $1,182	16%
Dean Health Insurance Med Adv	$153	16%
Quartz Mcr Adv	$153	16%
Security Health/First Health - All Plans	$153	16%
UnitedHealthcare	$153 - $1,212	16%
Humana	$207 - $1,364	22%
Dean Health Insurance Comm - All Other Plans	$217	23%
Dean Health Insurance Epo	$217	23%
Quartz Health Solutions - All Other Lans	$374	39%
Medicaid / KanCare	$460	48%
Blue Cross Blue Shield	$530	56%
Alliance - All Plans	$567	60%
Geha - All Plans	$1,137	120%
Cigna	$1,212	128%
Wisconsin Ppo Ppa Direct - All Plans	$1,212	128%
Wps - All Plans	$3,268	344%

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 $834.
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 Stoughton 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.