CMS Price Transparency Data

Colonoscopy with biopsy

Facility: South Peninsula Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,629
Cash Discount Price: $2,191
vs. Medicare Baseline: 2.15x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at South Peninsula Hospital is $2,629. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,191. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 2.15x the Medicare baseline. Located in 4300 Bartlett St, Homer, AK.

Cash / Self-Pay

$2,191

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,629

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: $2,191 (179%)

Insurance Median: $2,629 (215%)

Cash: $2,191 (179% of Medicare)

Ins. Median: $2,629 (215% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 215% of the Medicare baseline (a markup of 115%). 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
Liberty Healthshare - All Plans	$349	29%
UnitedHealthcare	$581	48%
Premera First - All Plans	$868	71%
Blue Cross Blue Shield	$1,034	85%
Aetna	$2,483	203%
Geha - All Plans	$2,629	215%
Meritain - All Plans	$2,629	215%
Teamsters Emply - All Plans	$2,629	215%
Ufcw - All Plans	$2,629	215%
Cigna	$2,775	227%
Great West - All Plans	$2,775	227%
Moda - All Plans	$2,775	227%
Multiplan Phcs - All Plans	$2,775	227%
Pmcs - All Plans	$2,775	227%
First Choice Health - All Plans	$2,863	234%

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 $2,191.
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 South Peninsula 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.