CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Piedmont Athens Regional Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $3,804
Cash Discount Price: $1,392
vs. Medicare Baseline: 3.11x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Piedmont Athens Regional Medical Center is $3,804. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,392. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 3.11x the Medicare baseline. Located in 1199 Prince Avenue, Athens, GA.

Cash / Self-Pay

$1,392

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,804

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: $1,392 (114%)

Insurance Median: $3,804 (311%)

Cash: $1,392 (114% of Medicare)

Ins. Median: $3,804 (311% 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 311% of the Medicare baseline (a markup of 211%). 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
Medicaid / KanCare	$494 - $519	40%
Blue Cross Blue Shield	$2,476 - $4,639	203%
Kaiser [10500]	$2,551	209%
UnitedHealthcare	$2,805 - $4,315	229%
Cigna	$3,155 - $4,586	258%
First Health [10303]	$3,247	266%
Novanet [10819]	$3,479	285%
Beechstreet [10800]	$3,804	311%
Multiplan [10600]	$3,804	311%
Phcs [10601]	$3,804	311%
Aetna	$4,201	344%
Alliant Health Plans Of Georgia [10952]	$4,639	379%

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 $1,392.
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 Piedmont Athens Regional Medical Center 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.