CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Emory Johns Creek Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $3,051
Cash Discount Price: $3,732
vs. Medicare Baseline: 2.50x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Emory Johns Creek Hospital is $3,051. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,732. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 2.50x the Medicare baseline. Located in 6325 Hospital Parkway, Johns Creek, GA.

Cash / Self-Pay

$3,732

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,051

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: $3,732 (305%)

Insurance Median: $3,051 (250%)

Cash: $3,732 (305% of Medicare)

Ins. Median: $3,051 (250% 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 250% of the Medicare baseline (a markup of 150%). 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
Devoted Health	$1,215	99%
Blue Cross Blue Shield	$1,228 - $5,051	100%
Aetna	$1,240 - $3,826	101%
Cigna	$1,252 - $4,797	102%
Clover Health	$1,276	104%
Wellcare	$1,288	105%
Ambetter / Centene	$2,577	211%
UnitedHealthcare	$2,912 - $3,425	238%
Kaiser	$3,051	250%
Oscar Health	$4,249	348%
Humana	$5,346	437%

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 $3,732.
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 Emory Johns Creek 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.