CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Cass County Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $182
Cash Discount Price: $637
vs. Medicare Baseline: 0.19x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Cass County Memorial Hospital is $182. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $637. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.19x the Medicare baseline. Located in 1501 East Tenth Street, Atlantic, IA.

Cash / Self-Pay

$637

Average discount available for prompt cash payment at this facility.

Insurance Median

$182

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: $637 (67%)

Insurance Median: $182 (19%)

Cash: $637 (67% of Medicare)

Ins. Median: $182 (19% 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
Triwest - All Plans	$148	16%
Aetna	$153 - $819	16%
Amerigroup Mcr Adv - All Other Plans	$153	16%
Medica Mcr Adv	$153	16%
Tricare	$153	16%
UnitedHealthcare	$153 - $286	16%
Va Ccn - All Plans	$153	16%
Wellmark Mcr Adv	$154	16%
Iowa Total Care Mcr	$156	16%
American Hlth Mcr Adv - All Plans	$157	17%
Iowa Total Care Comm - All Other Plans	$168	18%
Midlands Choice Medica Mcr	$182	19%
Wellmark Hmo	$352	37%
Wellmark Ppo - All Other Plans	$414	44%
Midlands Choice New Bus	$433	46%
Midlands Choice Pho (Ppo) - All Other Plans	$433	46%
Medica Comm - All Other Plans	$884	93%
Iowa Total Care Mcaid	$928	98%
Multiplan - All Plans	$954	100%
Medicaid / KanCare	$1,004	106%
Molina Mcaid - All Plans	$1,024	108%

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 $637.
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 Cass County Memorial Hospital 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.