CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Mercyone North Iowa Medical Center

Billing Code: 45380 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,209

about 1.0× the $1,223 Medicare rate · typically $680–$1,556

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,223

About the fair price

about $14 over the fair price · 1.0× Medicare

Medicare pays $1,223 Fair price $1,209 This hospital $1,223 Cash price $21,007

How we calculate the fair BaseRate →

How this hospital compares to other IA hospitals

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

Cheapest $165 Priciest $1,223

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

⚠ 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 $1,209 (about 1.0× the $1,223 Medicare rate). Mercyone North Iowa Medical Center charges insurers about $1,223, or about $21,007 in cash — about the fair price. Located in Mason City, IA.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Kaiser Permanente CignaHumana

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
UnitedHealthcaremajor	$1,289	105%
Blue Cross Blue Shieldmajor	$1,223 - $1,277	100%
Aetnamajor	$1,264	103%
Kaiser Permanentemajor	$1,223	100%
Ambetter (Centene)	$2,167	177%
Oscar Health	$1,700	139%
+ 11 smaller / regional plans	$70 - $2,592

Government programs also on file: Medicare, Medicaid.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 21,007), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 45380.

Insurance Before you use insurance

Call your insurance company to confirm Mercyone North Iowa Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 45380.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

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

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Mercyone North Iowa Medical Center

Compare: Colonoscopy with biopsy at other IA hospitals

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