CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Decatur County Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $360
Cash Discount Price: $377
vs. Medicare Baseline: 0.38x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Decatur County Hospital is $360. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $377. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.38x the Medicare baseline. Located in 1405 Nw Church Street, Leon, IA.

Cash / Self-Pay

$377

Average discount available for prompt cash payment at this facility.

Insurance Median

$360

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$950.1

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $950.1 (100%)

Cash / Self-Pay: $377 (40%)

Insurance Median: $360 (38%)

Cash: $377 (40% of Medicare)

Ins. Median: $360 (38% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $950.1 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	$153	16%
Tricare	$153	16%
UnitedHealthcare	$153 - $400	16%
Amerigroup Mcaid-All Plans	$160	17%
Everystep Hospice-All Plans	$245	26%
Misc Commercial-All Plans	$344	36%
Wellmark Hmo	$360	38%
Wellmark Ppo - All Other Plans	$360	38%
Rural Carrier Benefit Plan-All Plans	$363	38%
Christian Healthcare -All Plans	$377	40%
Midlands Choice-All Plans	$386	41%
Ntca The Rural Broadband-All Plans	$400	42%
Farm Bureau Financial-All Other Plans	$424	45%
Farm Bureau Property And Ca	$424	45%
Priority Health-All Plans	$471	50%
Iowa Total Care Mcaid-All Plans	$480	51%

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 $377.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Decatur County Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45378.
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.