CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Essentia Health Ada

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,471
Cash Discount Price: $2,264
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Essentia Health Ada is $1,471. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,264. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.20x the Medicare baseline. Located in 201 9Th Street West, Ada, MN.

Cash / Self-Pay

$2,264

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,471

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: $2,264 (185%)

Insurance Median: $1,471 (120%)

Cash: $2,264 (185% of Medicare)

Ins. Median: $1,471 (120% 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
Primewest	$1,138	93%
Itasca Med Care	$1,179	96%
Healthpartners Care Pmap	$1,192	98%
Medica Access	$1,219	100%
Sanford Health Plan	$1,314 - $1,383	107%
Advocare/Security Health	$1,471	120%
Blue Cross Blue Shield	$1,471 - $2,671	120%
Freedom Blue Ppo	$1,471	120%
Healthpartners Care Msho / Mcr Adv	$1,471	120%
Imcare Msho Pcc Prime	$1,471	120%
Imcare Msho Ref Req	$1,471	120%
Medica Advantage Solutions	$1,471	120%
Medica Msho/Dual Solutions	$1,471	120%
Medica Prime Solution Group	$1,471	120%
Medicare (plans)	$1,471	120%
Nd Va Administration	$1,471	120%
Platinum Blue/Vantage Blue	$1,471	120%
Primewest Msho	$1,471	120%
Secure Blue Msho	$1,471	120%
Ubh Cost Plan	$1,471	120%
Ubh Msho	$1,471	120%
Ucare Msho	$1,471	120%
UnitedHealthcare	$1,471 - $2,773	120%
Healthpartners	$1,863 - $2,038	152%
Ucare	$2,016	165%
Cigna	$2,038	167%
Healthpartners Pcc Prime	$2,038	167%
Wea	$2,206 - $2,359	180%
America'S Ppo	$2,375	194%
Medica	$2,546 - $2,681	208%
Medica Uplan	$2,546	208%
Wps	$2,574	211%
Aetna	$2,604	213%
Blue Plus Pmap Pcc Prime	$2,670	218%
Medica Choice	$2,761	226%

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 $2,264.
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 Essentia Health Ada 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.