CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Shenandoah Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $397
Cash Discount Price: $725
vs. Medicare Baseline: 0.42x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Shenandoah Medical Center is $397. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $725. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.42x the Medicare baseline. Located in 300 Pershing Avenue, Shenandoah, IA.

Cash / Self-Pay

$725

Average discount available for prompt cash payment at this facility.

Insurance Median

$397

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: $725 (76%)

Insurance Median: $397 (42%)

Cash: $725 (76% of Medicare)

Ins. Median: $397 (42% 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
UnitedHealthcare	$130 - $1,115	14%
Triwest Wellmark - All Plans	$151	16%
Aetna	$153	16%
Molina Mcr - All Other Plans	$153	16%
Tricare	$153	16%
Wellcare Mcr Adv - All Plans	$153	16%
Midlands Choice-All Plans	$381	40%
Blue Cross Blue Shield	$414	44%
Home State Health Plan Mcaid-All Plans	$1,115	117%
Molina Mcd	$1,115	117%
Nebraska Total Care Mcaid-All Plans	$1,115	117%
Iowa Total Care Mcaid-All Plans	$1,126	119%
Amerigroup Mcaid-All Plans	$1,137	120%

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 $725.
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 Shenandoah Medical Center 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.