CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Ruby Valley Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,858
Cash Discount Price: $2,827
vs. Medicare Baseline: 2.34x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Ruby Valley Medical Center is $2,858. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,827. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 2.34x the Medicare baseline. Located in 321 Madison St, Sheridan, MT.

Cash / Self-Pay

$2,827

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,858

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: $2,827 (231%)

Insurance Median: $2,858 (234%)

Cash: $2,827 (231% of Medicare)

Ins. Median: $2,858 (234% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 234% of the Medicare baseline (a markup of 134%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Medicare (plans)	$461 - $2,199	38%
Aetna	$593 - $2,984	49%
Medicaid / KanCare	$606 - $2,890	50%
Monida	$626 - $3,047	51%
Blue Cross Blue Shield	$2,827 - $3,141	231%
Cigna	$2,827 - $2,984	231%

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 $2,827.
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 Ruby Valley Medical 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.