CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Kossuth Regional Health Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,327
Cash Discount Price: $1,919
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Kossuth Regional Health Center is $1,327. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,919. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.09x the Medicare baseline. Located in 1515 South Phillips Street, Algona, IA.

Cash / Self-Pay

$1,919

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,327

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: $1,919 (157%)

Insurance Median: $1,327 (109%)

Cash: $1,919 (157% of Medicare)

Ins. Median: $1,327 (109% 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
Humana	$165 - $1,341	13%
Va Ccn - All Plans	$165 - $1,327	13%
Amerigroup Mcr Adv - All Other Plans	$168 - $1,354	14%
UnitedHealthcare	$170 - $2,651	14%
Mercy One - All Plans	$173 - $1,327	14%
Sanford Pho Isno Mcr Adv Profee Only - All Plans	$173	14%
Medical Associates - All Plans	$273 - $2,969	22%
Preferred Health - All Plans	$273 - $2,969	22%
Blue Cross Blue Shield	$382 - $1,366	31%
Health Partners New Bus - All Other Plans	$463 - $2,445	38%
Midlands Choice - All Plans	$485 - $2,445	40%
Health Partners Exisiting Bus	$509 - $3,388	42%
Aetna	$945 - $3,388	77%
Multiplan - All Plans	$1,240 - $3,318	101%
Molina Mcaid/Chip - All Plans	$1,338 - $3,598	109%
Amerigroup Mcaid	$1,344 - $3,633	110%

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 $1,919.
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 Kossuth Regional Health 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.