CMS Price Transparency Data

Colonoscopy with biopsy

Facility: PAM Specialty Hospital of Rocky Mount LLC

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,111
Cash Discount Price: $2,706
vs. Medicare Baseline: 1.73x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at PAM Specialty Hospital of Rocky Mount LLC is $2,111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,706. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.73x the Medicare baseline. Located in 1051 Noell Ln, Rocky Mount, NC.

Cash / Self-Pay

$2,706

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,111

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: $2,706 (221%)

Insurance Median: $2,111 (173%)

Cash: $2,706 (221% of Medicare)

Ins. Median: $2,111 (173% 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
America'S Choice	$1,895	155%
Provider Network Of America	$2,030	166%
Quik Trip	$2,030	166%
Usa Managed Care Organization	$2,030	166%
Velocity Provider Ppo Network	$2,030	166%
Healthsmart	$2,111	173%
Evolutions Healthcare System	$2,165	177%
Multiplan/Phcs	$2,165	177%
Fortified Provider Network	$2,301	188%
Prime Health Services	$2,301	188%
Integrated Health Plan	$2,571	210%

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 $2,706.
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 PAM Specialty Hospital of Rocky Mount LLC 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.