CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Penobscot Valley Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $580
Cash Discount Price: $1,488
vs. Medicare Baseline: 0.47x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Penobscot Valley Hospital is $580. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,488. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.47x the Medicare baseline. Located in 7 Transalpine Road, Po Box 368, Lincoln, ME.

Cash / Self-Pay

$1,488

Average discount available for prompt cash payment at this facility.

Insurance Median

$580

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: $1,488 (122%)

Insurance Median: $580 (47%)

Cash: $1,488 (122% of Medicare)

Ins. Median: $580 (47% 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
Wellcare Health Plan Inc Mcr Adv	$167 - $442	14%
Medicare (plans)	$190 - $873	16%
UnitedHealthcare	$190 - $891	16%
Humana	$192 - $503	16%
Blue Cross Blue Shield	$196 - $500	16%
Aetna	$514 - $1,820	42%
Harvard Pilgrim Healthcare	$580 - $1,811	47%
Cigna	$1,714 - $1,782	140%

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 $1,488.
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 Penobscot Valley 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.