CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Jefferson County Health Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $591
Cash Discount Price: $773
vs. Medicare Baseline: 0.48x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Jefferson County Health Center is $591. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $773. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.48x the Medicare baseline. Located in 2000 S Main, Fairfield, IA.

Cash / Self-Pay

$773

Average discount available for prompt cash payment at this facility.

Insurance Median

$591

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: $773 (63%)

Insurance Median: $591 (48%)

Cash: $773 (63% of Medicare)

Ins. Median: $591 (48% 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
UnitedHealthcare	$438 - $1,159	36%
Tricare	$500	41%
Amerigroup Mcr Adv	$515	42%
Humana	$515	42%
Iowa Total Care Comm - All Other Plans	$515	42%
Iowa Total Care Mcr	$515	42%
Molina Mcr Adv	$515	42%
Iowa Total Care Mcaid	$541	44%
Molina Mcaid/Chip	$541	44%
Medicaid / KanCare	$552	45%
Aetna	$631 - $1,159	52%
Medicare (plans)	$631	52%
Midlands New Product	$1,056	86%
Coventry Commercial Hmo	$1,095	90%
Coventry Commercial Ppo - All Other Plans	$1,159	95%
Midlands Choice-All Other Plans	$1,159	95%
Molina Marketplace - All Other Plans	$1,288	105%
Wellmark Hmo	$2,263	185%
Wellmark Indemnity/Ppo - All Other Plans	$2,490	204%

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 $773.
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 Jefferson County 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.