CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Sanford Hillsboro

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,904
Cash Discount Price: $1,846
vs. Medicare Baseline: 2.00x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Sanford Hillsboro is $1,904. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,846. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.00x the Medicare baseline. Located in 12 Third Street Se, Hillsboro, ND.

Cash / Self-Pay

$1,846

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,904

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: $1,846 (194%)

Insurance Median: $1,904 (200%)

Cash: $1,846 (194% of Medicare)

Ins. Median: $1,904 (200% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 200% of the Medicare baseline (a markup of 100%). 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
Sanford Health Plan Align	$1,052	111%
Ucare	$1,131 - $2,028	119%
Aetna	$1,140 - $2,006	120%
Blue Cross Blue Shield	$1,140 - $2,742	120%
Health Partners	$1,140 - $1,800	120%
Medicare (plans)	$1,140	120%
UnitedHealthcare	$1,140 - $1,927	120%
Primewest	$1,163	122%
Security Health Plan	$1,269	134%
Sanford Health Plan	$1,822 - $2,143	192%
Medica	$1,904 - $2,036	200%
First Choice Health Network	$2,077	219%
Healthez	$2,077	219%
Multiplan	$2,077	219%

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 $1,846.
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 Sanford Hillsboro 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.