CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Methodist Jennie Edmundson

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,456
Cash Discount Price: $728
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Methodist Jennie Edmundson is $1,456. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $728. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.19x the Medicare baseline. Located in 933 East Pierce Street, Council Bluffs, IA.

Cash / Self-Pay

$728

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,456

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: $728 (60%)

Insurance Median: $1,456 (119%)

Cash: $728 (60% of Medicare)

Ins. Median: $1,456 (119% 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
Medicare (plans)	$442 - $2,851	36%
Elite Choice - Mje	$845 - $2,498	69%
Blue Cross Blue Shield	$914 - $3,921	75%
Ambetter / Centene	$920 - $2,535	75%
Medica	$1,001 - $2,566	82%
Midlands Choice	$1,001 - $3,991	82%
Aetna	$1,032 - $4,779	84%
Ne Furniture Mart	$1,083 - $3,421	89%
Medica Choice	$1,178 - $2,851	96%
Humana	$1,205	99%
UnitedHealthcare	$1,223 - $3,421	100%
Wellmark	$2,210 - $2,431	181%

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 $728.
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 Methodist Jennie Edmundson 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.