CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Ottumwa Regional Health Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,251
Cash Discount Price: $2,596
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Ottumwa Regional Health Center is $1,251. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,596. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.02x the Medicare baseline. Located in 1001 E Pennsylvania, Ottumwa, IA.

Cash / Self-Pay

$2,596

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,251

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: $2,596 (212%)

Insurance Median: $1,251 (102%)

Cash: $2,596 (212% of Medicare)

Ins. Median: $1,251 (102% 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
UnitedHealthcare	$554 - $3,733	45%
Aetna	$570 - $1,206	47%
Molina Healthcare Of Iowa	$571	47%
Iowa Total Care Inc	$1,099	90%
Wellpoint Iowa, Inc.	$1,099 - $1,194	90%
Veteran Family Member Program	$1,108	91%
Humana	$1,211	99%
Wellmark Health Plan Of Iowa	$1,291	106%
Blue Cross Blue Shield	$1,422	116%
Wellmark Value Health Plan Inc	$2,425	198%
Cigna	$6,284	514%

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 $2,596.
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 Ottumwa Regional Health 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.