CMS Price Transparency Data

Colonoscopy with biopsy

Facility: St Anthony Regional Hospital & Nursing Home

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $263
Cash Discount Price: $1,380
vs. Medicare Baseline: 0.22x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at St Anthony Regional Hospital & Nursing Home is $263. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,380. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.22x the Medicare baseline. Located in 311 South Clark Street, Carroll, IA.

Cash / Self-Pay

$1,380

Average discount available for prompt cash payment at this facility.

Insurance Median

$263

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: $1,380 (113%)

Insurance Median: $263 (22%)

Cash: $1,380 (113% of Medicare)

Ins. Median: $263 (22% 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
Midlands Choice - All Plans	$77	6%
Aetna	$165 - $692	13%
Humana	$165 - $1,173	13%
Medica Mcr - All Plans	$165	13%
UnitedHealthcare	$165 - $264	13%
Va Ccn - All Plans	$165	13%
Wellpoint Mcr Adv	$165	13%
Ia Total Care Mcr	$170	14%
Ia Total Care Comm - All Other Plans	$215	18%
Wellmark Hmo	$382	31%
Wellmark Ppo-All Other Plans	$450	37%
Ia Total Care Mcaid	$1,380	113%
Wellpoint Mcaid - All Other Plans	$1,380	113%
Molina Mcaid - All Plans	$1,408	115%

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 $1,380.
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 St Anthony Regional Hospital & Nursing Home 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.