CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Orange City Area Health System

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $438
Cash Discount Price: $502
vs. Medicare Baseline: 0.36x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Orange City Area Health System is $438. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $502. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.36x the Medicare baseline. Located in 1000 Lincoln Circle Se, Orange City, IA.

Cash / Self-Pay

$502

Average discount available for prompt cash payment at this facility.

Insurance Median

$438

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: $502 (41%)

Insurance Median: $438 (36%)

Cash: $502 (41% of Medicare)

Ins. Median: $438 (36% 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
Avera-All Plans	$377	31%
Wellmark Hmo	$391	32%
UnitedHealthcare	$416	34%
Midlands Choice-All Plans	$418	34%
Wellmark Ppo - All Other Plans	$459	38%
Health Partners Coordinated-All Other Plans	$480	39%
Health Partners Open	$528	43%
Sanford Health-All Plans	$752	62%

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 $502.
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 Orange City Area Health System 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.