CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Cannon Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $190
Cash Discount Price: $154
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Cannon Memorial Hospital is $190. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $154. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.16x the Medicare baseline. Located in 123 W G Acker Drive, Pickens, SC.

Cash / Self-Pay

$154

Average discount available for prompt cash payment at this facility.

Insurance Median

$190

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: $154 (13%)

Insurance Median: $190 (16%)

Cash: $154 (13% of Medicare)

Ins. Median: $190 (16% 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
Medicaid / KanCare	$132 - $170	11%
Absolute Total Care [58]	$135 - $174	11%
Humana	$138 - $1,207	11%
Select Health Of Sc [637]	$138 - $152	11%
Aetna	$181 - $290	15%
Blue Choice Health Plan [922]	$181 - $481	15%
Blue Cross Blue Shield	$181 - $481	15%
Devoted Health Alt Payer [9401]	$181 - $185	15%
Devoted Health [94]	$181 - $185	15%
Medicare (plans)	$181 - $208	15%
UnitedHealthcare	$181 - $326	15%
Vaccn - Va Community Care Network [16]	$181	15%
Veterans Administration [633]	$181	15%
Cigna	$187 - $350	15%
Molina Dual Options Alt Payer [1501]	$187	15%
Molina Dual Options [15]	$187	15%
Absolute Total Care Mcr Plans Alt Payer [4101]	$188	15%
Absolute Total Care Mcr Plans [41]	$188	15%
Champva [604]	$189	15%
Tricare	$189	15%
First Choice Vip Careplus Alt Payer [3301]	$190	16%
First Choice Vip [33]	$190	16%
Nhc Advantage Alt Payer [6101]	$190	16%
Nhc Advantage [61]	$190	16%
Bright Health Alt Payer [1001]	$193 - $208	16%
Bright Health [11]	$258	21%
Ambetter / Centene	$259	21%
First Choice Next [96]	$263	22%
Molina Marketplace [97]	$263	22%
Employee Benefit Management Services [869]	$283	23%
Mail Handlers Benefit Plan [327]	$290	24%
Rural Carrier Benefit Plan [406]	$290	24%
Workers Compensation [622]	$292	24%
Edison Health Solutions [95]	$317	26%
Healthscope [98]	$317	26%
Geha [302]	$326	27%
Golden Rule Ins Co [584]	$326	27%
Nalc Health Benefit Plan [291]	$350	29%
Preferred Administrators [19]	$354	29%
Medcost [206]	$412	34%
Planned Administrators [886]	$481	39%
Thomas Cooper & Company [315]	$481	39%
Phcs [940]	$519	42%

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 $154.
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 Cannon Memorial 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.