CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Sanford Medical Center Fargo

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,830
Cash Discount Price: $2,662
vs. Medicare Baseline: 1.50x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Sanford Medical Center Fargo is $1,830. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,662. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.50x the Medicare baseline. Located in 801 Broadway North, Fargo, ND.

Cash / Self-Pay

$2,662

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,830

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: $2,662 (218%)

Insurance Median: $1,830 (150%)

Cash: $2,662 (218% of Medicare)

Ins. Median: $1,830 (150% 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
Sanford Health Plan	$197	16%
Blue Cross Blue Shield	$860 - $2,084	70%
Sanford Health Plan Align	$1,120	92%
Ucare	$1,203 - $2,339	98%
Aetna	$1,214 - $2,845	99%
Health Partners	$1,214 - $1,364	99%
Medicare (plans)	$1,214	99%
UnitedHealthcare	$1,214 - $2,899	99%
Primewest	$1,237 - $1,238	101%
Medica	$1,498 - $1,601	123%
Security Health Plan	$1,830	150%
Cigna	$2,995	245%
First Choice Health Network	$2,995	245%
Healthez	$2,995	245%
Multiplan	$2,995	245%

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 $2,662.
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 Sanford Medical Center Fargo 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.