CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Mercyone North Iowa Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,223
Cash Discount Price: $21,007
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Mercyone North Iowa Medical Center is $1,223. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21,007. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.00x the Medicare baseline. Located in 1000 Fourth Street Sw, Mason City, IA.

Cash / Self-Pay

$21,007

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,223

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: $21,007 (1718%)

Insurance Median: $1,223 (100%)

Cash: $21,007 (1718% of Medicare)

Ins. Median: $1,223 (100% 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
Iowa Dept Of Public Health	$70 - $94	6%
Iowa Total Care	$1,158	95%
Medicaid / KanCare	$1,169 - $1,174	96%
Bcn Domestic	$1,223	100%
Blue Benefit Administrators Of Massachusetts	$1,223	100%
Blue Care Network	$1,223	100%
Blue Cross Blue Shield	$1,223 - $1,277	100%
Blue Distinction Transplant	$1,223	100%
Blue Shield - Ca	$1,223	100%
Blue Shield - Id (Regence)	$1,223	100%
Blue Shield - Ny Highmark Northeastern	$1,223	100%
Blue Shield - Ny Highmark Western	$1,223	100%
Blue Shield - Pa (Highmark)	$1,223	100%
Blue Shield - Wa (Regence)	$1,223	100%
Kaiser Domestic	$1,223	100%
Pre-Employment	$1,223	100%
Wc Domestic	$1,223	100%
Aetna	$1,264	103%
Medicare (plans)	$1,264 - $1,316	103%
UnitedHealthcare	$1,289	105%
Centivo	$1,586	130%
Oscar	$1,700	139%
Amish Hospital Aid	$1,715	140%
Ambetter / Centene	$2,167	177%
Claimdoc	$2,592	212%
Nova	$2,592	212%

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 $21,007.
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 Mercyone North Iowa Medical Center 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.