CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Atrium Health Navicent Rehabilitation Hopsital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $938
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.77x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Atrium Health Navicent Rehabilitation Hopsital is $938. 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 0.77x the Medicare baseline. Located in 3351 Northside Dr, Macon, GA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$938

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: $938 (77%)

Ins. Median: $938 (77% 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
Aetna	$187 - $1,889	15%
Blue Cross Blue Shield	$187 - $3,157	15%
Georgia Health Advantage	$187 - $1,179	15%
Humana	$187 - $4,453	15%
UnitedHealthcare	$187 - $1,179	15%
Care Source	$191 - $1,203	16%
Clover	$191 - $1,203	16%
Eon Health	$191 - $1,203	16%
Pruitt Health	$197 - $1,179	16%
Alliant	$225 - $2,242	18%
Ambetter / Centene	$253	21%
Cigna	$701 - $2,875	57%
Securehealth	$869	71%
Kaiser	$938 - $1,884	77%
Ibg	$964	79%

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 Atrium Health Navicent Rehabilitation Hopsital 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.