CMS Price Transparency Data

Colonoscopy with biopsy

Facility: East Georgia Regional Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,768
Cash Discount Price: $4,222
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at East Georgia Regional Medical Center is $1,768. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,222. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.45x the Medicare baseline. Located in 1499 Fair Road, Statesboro, GA.

Cash / Self-Pay

$4,222

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,768

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: $4,222 (345%)

Insurance Median: $1,768 (145%)

Cash: $4,222 (345% of Medicare)

Ins. Median: $1,768 (145% 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
Veterans Eval Services	$383	31%
Medicaid / KanCare	$910 - $955	74%
Peach State Hlth Plan Mcaid Ga	$928	76%
UnitedHealthcare	$955 - $6,199	78%
Humana	$1,123	92%
Medicare (plans)	$1,123	92%
Node Clover Health Mcr Adv	$1,123	92%
Tricare	$1,130	92%
Health Net Va	$1,141	93%
Node Non Par Hospice Agree	$1,141	93%
Node Va	$1,141	93%
Caresource Mcr Adv	$1,179	96%
Node Champva	$1,190	97%
Node Us Dept Of Labor	$1,427	117%
Department Of Health	$1,496	122%
Ambetter / Centene	$2,040	167%
Caresource Exchange	$2,054	168%
Blue Cross Blue Shield	$2,260 - $5,929	185%
Ga Work Comp	$3,089	253%
Prime Health Work Comp	$3,089	253%
Three Rivers Wc	$3,089	253%
Self Pay	$4,222	345%
Industry Buying Group	$6,567	537%
Ibg	$7,036	576%
Coventry	$8,913	729%
Three Rivers Provider Network	$9,382	767%
First Health	$11,727	959%
Aetna	$12,509 - $12,618	1023%
Prime Health Commercial	$12,509	1023%
Novanet	$13,291	1087%

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 $4,222.
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 East Georgia 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.