CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Blount Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,281
Cash Discount Price: $1,163
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Blount Memorial Hospital is $1,281. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,163. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.05x the Medicare baseline. Located in 907 E Lamar Alexander Parkway, Maryville, TN.

Cash / Self-Pay

$1,163

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,281

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: $1,163 (95%)

Insurance Median: $1,281 (105%)

Cash: $1,163 (95% of Medicare)

Ins. Median: $1,281 (105% 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	$578 - $988	47%
UnitedHealthcare	$578 - $1,337	47%
Prisma Health Seniorcare Pace - Midlands [5400]	$870	71%
Prisma Health Seniorcare Pace-Upstate [5200]	$870	71%
Cigna	$920 - $1,525	75%
Tricare	$1,098	90%
Blue Cross Blue Shield	$1,125 - $1,170	92%
Humana	$1,125	92%
Medicare (plans)	$1,125 - $1,170	92%
Golden Rule Insurance Company [2991]	$1,190	97%
Oxford Health Plans [2992]	$1,190	97%
Bob Jones Univ-Pai [821]	$1,249	102%
Promise Health Plan Contracted [2401]	$1,313 - $2,251	107%
Orangeburg Senior Helping Center Pace [5401]	$1,501	123%
Mvp Health Care [3037]	$1,525	125%
Ambetter / Centene	$1,761	144%
Consociate Health Contracted [4835]	$2,499	204%
Fairos/Occunet Contracted [4837]	$2,613	214%
Preferred Administrators Contracted [2839]	$2,626	215%
Medcost [2940]	$2,776 - $3,114	227%
Atlantic Packaging Contracted [4833]	$2,814	230%
Aps Healthcare System [2981]	$3,002	246%
Multiplan/Phcs Contracted [2950]	$3,339	273%
Aetna	$3,377	276%
Meritain Health Contracted [2200]	$3,377	276%
Nippon [2300]	$3,377	276%
Vsp Vision Care [2986]	$3,377	276%
First Health Contracted [2952]	$3,489	285%
Furman Int/Allen University Student [2951]	$3,489	285%
Quiktrip-First Health [3067]	$3,489	285%

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 $1,163.
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 Blount 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.