CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Madison County Health Care System

Billing Code: 45380 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$376

about 0.3× the $1,223 Medicare rate · typically $183–$1,427

modeled estimate · not a bill or quote

What this hospital charges insurers

$375

About the fair price

about $1 under the fair price · 0.3× Medicare

Medicare pays $1,223 Fair price $376 This hospital $375 Cash price $1,758 Hospital's list price $2,198

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 $375

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 $376 (about 0.3× the $1,223 Medicare rate). Madison County Health Care System charges insurers about $375, or about $1,758 in cash — about the fair price. Located in Winterset, IA.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna CignaHumanaKaiser Permanente

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	$165 - $2,781	13%
Blue Cross Blue Shieldmajor	$378 - $2,522	31%
Aetnamajor	$165 - $2,008	13%
Amerigroup	$1,384 - $1,539	113%
Molina	$1,339 - $1,503	110%
Oscar Health	$286 - $1,993	23%
+ 14 smaller / regional plans	$165 - $3,090

Government programs also on file: Military & VA.

Excludes 4 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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 1,758), 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 Madison County Health Care System 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 Madison County Health Care System

Compare: Colonoscopy with biopsy at other IA hospitals

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