Skip to main content
States Procedures Methodology Search
CMS Price Transparency Data Hospital file updated: 2026-08-06

Colonoscopy with biopsy

Facility: PAM Health Rehabiltation Hospital of Wausau

Billing Code: 45380 (CPT)

Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Above Fair Market · Negotiate
$1,165Fair BaseRate (1.06× Market)
Position vs. 1.00× Fair Price+6% Above Fair Price 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

This hospital's typical commercial price is $1,236 compared to the $1,165 fair price benchmark.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.Regional Quality Benchmark
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety ScoreNot ScoredComposite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

The BaseRate · fair price low confidence
A fair price for this
$1,165
about 1.0× the $1,223 Medicare rate · typically $262–$2,909
modeled estimate · not a bill or quote
What this hospital charges insurers
$1,236
About the fair price
about $71 over the fair price · 1.0× Medicare
Medicare pays $1,223 Fair price $1,165 This hospital $1,236 Cash price $4,872 Hospital's list price $4,872

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $166 Priciest $1,236

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

Note: 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 with biopsy is about $1,165 (about 1.0× the $1,223 Medicare rate). PAM Health Rehabiltation Hospital of Wausau charges insurers about $1,236, or about $4,872 in cash — about the fair price. Located in Wausau, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

1 of 6 major insurers have a published price at this hospital

Aetna UnitedHealthcareBlue Cross Blue ShieldCignaHumanaKaiser 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
Aetnamajor $1,124 - $3,897 92%
Medica $2,046 167%
+ 7 smaller / regional plans $1,067 - $3,654
Excludes 4 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Insurance Before you use insurance

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

Enter your details and press estimate to compare.

Facility Profile & Credentials

  • Address: 1111 Westwood Dr, Wausau, WI 54401
  • CMS Rating: No CMS Rating
  • Ownership Type: N/A
  • Hospital Type: PART A PROVIDER - HOSPITAL

Other Procedures at PAM Health Rehabiltation Hospital of Wausau

Compare: Colonoscopy with biopsy at other WI hospitals

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

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%

Audit a Bill or Quote at PAM Health Rehabiltation Hospital of Wausau (Zero PHI Required)

CMS CCN: 523034
CPT 45380
Fair BaseRate™ $1,165
Medicare Rate $1,223
Self-Pay Cash $4,872
Insurer Median $1,236
Pre-filled with PAM Health Rehabiltation Hospital of Wausau’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $1,769 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $1,769

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $1,769).

Step 2 · Cash vs. Insurance Arbitrage Published Cash: $4,872

Compare Prompt-Pay Cash Rate Against Remaining Deductible

PAM Health Rehabiltation Hospital of Wausau's published 45 CFR § 180 self-pay cash rate is $4,872 (vs. $1,236 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$3,707 Above Fair BaseRate

Negotiate Toward $1,165 Fair BaseRate ($1,223 Medicare)

Your bill ($4,872) is $3,707 above the denoised Fair BaseRate ($1,165) and 4.0× the $1,223 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

45 CFR § 180 Primary-Source Lineage & Federal Verification Verified CMS CCN 523034

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (874772758_pam-rehabilitation-hospital-of-wausau-llc_standardcharges.csv) Verify on CMS Medicare.gov (CCN 523034) ↗ CMS HCRIS Cost Reports ↗
Published MRF File874772758_pam-rehabilitation-hospital-of-wausau-llc_standardcharges.csv
Publication / Vintage2026-08-06 · 96.19 MB
Validated Rate Rows1,003,915 (CMS v3.0.0)
File Integrity DigestVerified · CCN 523034

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy