CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Audubon County Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,340
Cash Discount Price: $2,250
vs. Medicare Baseline: 1.91x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Audubon County Memorial Hospital is $2,340. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,250. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.91x the Medicare baseline. Located in 515 Pacific Avenue, Audubon, IA.

Cash / Self-Pay

$2,250

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,340

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: $2,250 (184%)

Insurance Median: $2,340 (191%)

Cash: $2,250 (184% of Medicare)

Ins. Median: $2,340 (191% 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
Aetna	$165 - $2,925	13%
Tricare	$165 - $2,340	13%
Wellmark Hmo	$379 - $2,582	31%
Wellmark Ppo - All Other Plans	$446 - $2,844	36%
UnitedHealthcare	$643 - $2,762	53%
Molina Mcaid - All Plans	$1,250 - $3,250	102%
Iowa Total Care Mcaid - All Plans	$1,262 - $3,282	103%
Amerigroup Mcaid - All Plans	$1,312 - $3,412	107%
Midlands Choice - All Plans	$3,185	261%

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 $2,250.
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 Audubon County Memorial Hospital 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.