CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Pelham Medical Center

Billing Code: 45380 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,621

about 1.3× the $1,223 Medicare rate · typically $1,207–$2,142

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,205

Below the fair price — a good deal

about $416 under the fair price · 1.0× Medicare

Medicare pays $1,223 Fair price $1,621 This hospital $1,205 Cash price $4,174 Hospital's list price $6,957

How we calculate the fair BaseRate →

How this hospital compares to other SC hospitals

Highest price of the 9 SC hospitals we have prices for — worth calling around.

Cheapest $258 Priciest $1,205

Black dot = this hospital, among the 9 SC hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Colonoscopy with biopsy is about $1,621 (about 1.3× the $1,223 Medicare rate). Pelham Medical Center charges insurers about $1,205, or about $4,174 in cash — below the fair price — a good deal. Located in Greer, SC.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$6,132	502%
Blue Cross Blue Shieldmajor	$833 - $3,064	68%
Aetnamajor	$1,187	97%
Cignamajor	$1,221 - $6,802	100%
Humanamajor	$1,141	93%
Devoted Health	$1,175	96%
Health Net	$6,917	566%
+ 1 smaller / regional plan	$1,198

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 4,174), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 45380.

Insurance Before you use insurance

Call your insurance company to confirm Pelham Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 45380.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Pelham Medical Center

Compare: Colonoscopy with biopsy at other SC hospitals

Insurance negotiated median for the same procedure, sorted lowest first.