CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Washington County Hospital and Clinics

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $307
Cash Discount Price: $719
vs. Medicare Baseline: 0.32x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Washington County Hospital and Clinics is $307. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $719. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.32x the Medicare baseline. Located in 400 East Polk Street, Washington, IA.

Cash / Self-Pay

$719

Average discount available for prompt cash payment at this facility.

Insurance Median

$307

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: $719 (76%)

Insurance Median: $307 (32%)

Cash: $719 (76% of Medicare)

Ins. Median: $307 (32% 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
Molina Mcr Adv - All Other Plans	$157	17%
Healthpartners Mcr Adv	$162	17%
Med Assoc Mcr Adv	$165	17%
Blue Cross Blue Shield	$166 - $414	17%
Health Alliance Mcr Adv	$168	18%
Humana	$168	18%
Ia Total Care Wellcare Mcr Adv	$170	18%
Wellpoint Mcr Adv Amerigrp - All Other Plans	$170	18%
Aetna	$175 - $307	18%
Med Assoc Hlth Choices Profee Only - All Otherplan	$379	40%
Ambetter / Centene	$400	42%
Midlands Choice - All Plans	$402	42%
Healthpartners - All Other Plans	$436	46%
Health Alliance Comm - All Other Plans	$730	77%
Ia Total Care Mcaid	$958	101%
Medicaid / KanCare	$958	101%
Wellpoint Mcaid Amerigrp	$958	101%

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 $719.
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 Washington County Hospital and Clinics 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.