CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Doctors Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,635
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.16x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Doctors Hospital is $2,635. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 2.16x the Medicare baseline. Located in 3651 Wheeler Road, Augusta, GA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,635

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%)

Insurance Median: $2,635 (216%)

Ins. Median: $2,635 (216% 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 216% of the Medicare baseline (a markup of 116%). 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
Blue Choice	$1,020 - $1,529	83%
Peach State	$1,150	94%
Wellcare	$1,150	94%
Health One Alliance	$1,230	101%
Blue Cross Blue Shield	$2,134 - $2,825	175%
Americas 1St Choice	$2,205	180%
Amerigroup	$2,365	193%
Cigna	$2,412 - $3,132	197%
Nhc Advantage	$2,550	209%
Pruitt Health	$2,550	209%
Aetna	$2,595 - $3,633	212%
Prime Health	$2,965	243%
Rockport United Network	$3,027	248%
Identity Mco	$3,089	253%
United	$3,224	264%
Friday Health	$3,708	303%
Centurion	$7,512	614%

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 $X.
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 Doctors 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.