CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Harlan County Health System

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $726
Cash Discount Price: $1,258
vs. Medicare Baseline: 0.59x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Harlan County Health System is $726. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,258. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.59x the Medicare baseline. Located in 717 Brown St, Alma, NE.

Cash / Self-Pay

$1,258

Average discount available for prompt cash payment at this facility.

Insurance Median

$726

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: $1,258 (103%)

Insurance Median: $726 (59%)

Cash: $1,258 (103% of Medicare)

Ins. Median: $726 (59% 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
Aetna	$165 - $941	13%
Medica Chi Health	$165 - $1,223	13%
Medica Mcr Adv	$165 - $726	13%
Medica Prime Solution	$165 - $726	13%
Tricare	$165 - $900	13%
UnitedHealthcare	$165 - $1,800	13%
Great Plains Mcr Adv-All Plans	$174 - $946	14%
Medica Ifb Aco	$300 - $1,290	25%
Blue Cross Blue Shield	$316 - $1,290	26%
Medica Chi Aco - All Other Plans	$316 - $1,223	26%
Medica Choice	$331 - $1,223	27%
Medica Ifb Open Access	$383 - $1,290	31%
Phcs/Multiplan-All Plans	$494 - $1,317	40%
Humana	$900	74%
Ohara Llc Wc- All Plans	$1,277 - $1,710	104%
Ambetter / Centene	$1,836	150%
Healthy Blue Mcaid-All Plans	$1,890	155%

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 $1,258.
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 Harlan County Health System 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.