CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Southwest Health Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,428
Cash Discount Price: $2,306
vs. Medicare Baseline: 2.56x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Southwest Health Center is $2,428. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,306. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.56x the Medicare baseline. Located in 1400 East Side Rd, Platteville, WI.

Cash / Self-Pay

$2,306

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,428

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: $2,306 (243%)

Insurance Median: $2,428 (256%)

Cash: $2,306 (243% of Medicare)

Ins. Median: $2,428 (256% 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 256% of the Medicare baseline (a markup of 156%). 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
Care Wisconsin	$922 - $1,998	97%
Blue Cross Blue Shield	$922 - $3,074	97%
UnitedHealthcare	$953 - $2,521	100%
Quartz	$1,906 - $2,398	201%
Wps	$2,306	243%
Cigna	$2,306	243%
Group Health Cooperative of Sc	$2,459 - $2,674	259%
Humana	$2,767	291%
Healthchoice	$2,920	307%
Group Health South Central	$3,074	324%
Group Health Eau Claire	$3,074	324%
Dean Health Plan	$3,398	358%

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 $2,306.
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 Southwest Health Center 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.