CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Cherry County Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,402
Cash Discount Price: $2,194
vs. Medicare Baseline: 1.15x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Cherry County Hospital is $1,402. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,194. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.15x the Medicare baseline. Located in 510 North Green St, Valentine, NE.

Cash / Self-Pay

$2,194

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,402

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: $2,194 (179%)

Insurance Median: $1,402 (115%)

Cash: $2,194 (179% of Medicare)

Ins. Median: $1,402 (115% 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
Molina Mcr Adv	$174 - $1,607	14%
Avera Hmo	$231 - $2,855	19%
Molina Mcaid - All Other Plans	$237 - $1,832	19%
Ambetter / Centene	$266	22%
Midwest Ntwrk Profee Only - All Plans	$331	27%
Oscar Profee Only - All Plans	$331	27%
Avera Aca Ppo	$384 - $2,855	31%
Midlands Choice-All Plans	$398 - $2,826	33%
Avera Aso Ppo	$407 - $2,855	33%
Avera Non-Aca Ppo - All Other Plans	$424 - $2,855	35%
UnitedHealthcare	$558 - $2,841	46%
First Choice-All Plans	$1,402 - $2,855	115%
Multiplan-All Plans	$1,402 - $2,855	115%
Phcs-All Plans	$1,402 - $2,855	115%
Tlc Advantage-All Plans	$1,402 - $2,855	115%
Blue Cross Blue Shield	$2,826	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 $2,194.
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 Cherry County Hospital 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.