CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Wentworth-Douglass Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,244
Cash Discount Price: $3,464
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Wentworth-Douglass Hospital is $1,244. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,464. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.02x the Medicare baseline. Located in 789 Central Ave, Dover, NH.

Cash / Self-Pay

$3,464

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,244

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: $3,464 (283%)

Insurance Median: $1,244 (102%)

Cash: $3,464 (283% of Medicare)

Ins. Median: $1,244 (102% 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
Generic Commercial [1009]	$672 - $833	55%
Wellsense Nh [1050]	$672 - $1,232	55%
Blue Cross Blue Shield	$1,207 - $7,873	99%
Martin's Point [160007]	$1,232	101%
Medicare (plans)	$1,232	101%
Tricare	$1,232	101%
UnitedHealthcare	$1,232 - $4,469	101%
Aetna	$1,256 - $4,030	103%
Humana	$1,269	104%
Cigna	$3,285	269%
Mgb Health Plan [150001]	$3,632	297%

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 $3,464.
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 Wentworth-Douglass 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.