CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Alice Peck Day Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,479
Cash Discount Price: $1,141
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Alice Peck Day Memorial Hospital is $1,479. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,141. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.21x the Medicare baseline. Located in 10 Alice Peck Day Drive, Lebanon, NH.

Cash / Self-Pay

$1,141

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,479

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: $1,141 (93%)

Insurance Median: $1,479 (121%)

Cash: $1,141 (93% of Medicare)

Ins. Median: $1,479 (121% 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
Ambetter / Centene	$175	14%
Nh Healthy Families	$182	15%
Medicaid / KanCare	$750 - $1,194	61%
Blue Cross Blue Shield	$808 - $2,315	66%
Harvard Pilgrim	$1,016 - $2,255	83%
UnitedHealthcare	$1,176 - $1,873	96%
Tufts	$1,198 - $1,907	98%
Cigna	$1,252 - $2,128	102%
Commercial Generic	$1,252 - $1,992	102%
Connecticut General	$1,252 - $1,992	102%
Klais	$1,263 - $2,011	103%
Wellpoint	$1,284 - $2,044	105%
Aetna	$1,471 - $2,341	120%
Mvp	$1,487 - $2,367	122%
Coventry Health	$1,552 - $2,471	127%
Coventry Health Wc	$1,552 - $2,471	127%
Humana	$1,699 - $2,705	139%

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 $1,141.
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 Alice Peck Day Memorial 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.