CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Blount Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,187
Cash Discount Price: $1,096
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Blount Memorial Hospital is $1,187. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,096. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.25x the Medicare baseline. Located in 907 E Lamar Alexander Parkway, Maryville, TN.

Cash / Self-Pay

$1,096

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,187

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$950.1

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $950.1 (100%)

Cash / Self-Pay: $1,096 (115%)

Insurance Median: $1,187 (125%)

Cash: $1,096 (115% of Medicare)

Ins. Median: $1,187 (125% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $950.1 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	$545 - $882	57%
UnitedHealthcare	$545 - $1,190	57%
Prisma Health Seniorcare Pace - Midlands [5400]	$821	86%
Prisma Health Seniorcare Pace-Upstate [5200]	$821	86%
Tricare	$849	89%
Blue Cross Blue Shield	$874 - $909	92%
Humana	$874	92%
Medicare (plans)	$874 - $909	92%
Cigna	$909 - $1,185	96%
Bob Jones Univ-Pai [821]	$1,007	106%
Mvp Health Care [3037]	$1,185	125%
Golden Rule Insurance Company [2991]	$1,190	125%
Oxford Health Plans [2992]	$1,190	125%
Promise Health Plan Contracted [2401]	$1,238 - $2,122	130%
Ambetter / Centene	$1,368	144%
Orangeburg Senior Helping Center Pace [5401]	$1,415	149%
Consociate Health Contracted [4835]	$1,942	204%
Fairos/Occunet Contracted [4837]	$2,031	214%
Preferred Administrators Contracted [2839]	$2,476	261%
Medcost [2940]	$2,617 - $2,936	275%
Atlantic Packaging Contracted [4833]	$2,653	279%
Aps Healthcare System [2981]	$2,830	298%
Multiplan/Phcs Contracted [2950]	$3,148	331%
Aetna	$3,183	335%
Meritain Health Contracted [2200]	$3,183	335%
Nippon [2300]	$3,183	335%
Vsp Vision Care [2986]	$3,183	335%
First Health Contracted [2952]	$3,289	346%
Furman Int/Allen University Student [2951]	$3,289	346%
Quiktrip-First Health [3067]	$3,289	346%

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 $1,096.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Blount Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45378.
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.