CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Mercyone Elkader Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $843
Cash Discount Price: $10,867
vs. Medicare Baseline: 0.69x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Mercyone Elkader Medical Center is $843. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,867. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.69x the Medicare baseline. Located in 901 Davidson Street Nw, Elkader, IA.

Cash / Self-Pay

$10,867

Average discount available for prompt cash payment at this facility.

Insurance Median

$843

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: $10,867 (889%)

Insurance Median: $843 (69%)

Cash: $10,867 (889% of Medicare)

Ins. Median: $843 (69% 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	$94 - $1,597	8%
Aetna	$165 - $1,175	13%
Blue Cross Blue Shield	$822	67%
Medicare (plans)	$839 - $863	69%
UnitedHealthcare	$880 - $1,397	72%
Iowa Total Care	$994	81%
Medicaid / KanCare	$1,008 - $1,013	82%
Amish Hospital Aid	$1,104	90%
1199 National Benefit Fund	$1,175	96%
Allied Benefit Systems	$1,175	96%
Asr Health Benefits	$1,175	96%
Christian Brother Services	$1,175	96%
Coventry	$1,175	96%
First Health	$1,175	96%
Lucent Health	$1,175	96%
Luminare Health	$1,175	96%
Medical Mutual	$1,175	96%
Meritain	$1,175	96%
Trustmark Small Business Benefits	$1,175	96%
Webtpa	$1,175	96%
Centivo	$1,246	102%
Health Choices	$1,278	105%
Medical Associates	$1,278	105%
Ambetter / Centene	$1,395	114%
Geha	$1,397	114%
Health Partners	$1,536	126%
Auxiant	$1,565	128%
Cigna	$1,565	128%
Medica	$1,565	128%
Midlands	$1,565	128%
Midlands Choice	$1,565	128%
Crime Victim Assistance	$1,597	131%
Claimdoc	$1,669	137%
Nova	$1,669	137%

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 $10,867.
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 Elkader 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.