CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Tri Valley Health System

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $522
Cash Discount Price: $1,483
vs. Medicare Baseline: 0.43x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Tri Valley Health System is $522. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,483. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.43x the Medicare baseline. Located in 1305 West Highway 6/34, Cambridge, NE.

Cash / Self-Pay

$1,483

Average discount available for prompt cash payment at this facility.

Insurance Median

$522

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: $1,483 (121%)

Insurance Median: $522 (43%)

Cash: $1,483 (121% of Medicare)

Ins. Median: $522 (43% 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
Blue Cross Blue Shield	$165 - $2,098	13%
Humana	$165 - $479	13%
Medica Mcr Adv	$165 - $479	13%
Medica Prime Sol	$165 - $479	13%
Tricare	$165 - $479	13%
Wellcare Mcr Adv - All Plans	$170 - $479	14%
Aetna	$174 - $2,164	14%
Great Plains Mcr Adv - All Plans	$174 - $503	14%
Medica Ifb Aco	$324 - $1,987	27%
Medica Chi Aco - All Other Plans	$335 - $1,987	27%
Medica Chi Open Access	$357 - $1,987	29%
Healthy Blue Mcaid - All Plans	$408 - $1,060	33%
Molina Mcaid - All Plans	$408 - $1,060	33%
UnitedHealthcare	$408 - $2,120	33%
Nebraska Total Care-All Plans	$412 - $1,060	34%
Medica Ifb Open Access	$414 - $1,987	34%
Amerigroup Mcaid - All Plans	$416 - $1,081	34%
Multiplan-All Plans	$534 - $2,164	44%
Midlands Choice-All Plans	$801 - $1,987	66%

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 $1,483.
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 Tri Valley 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.