CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Tennova Healthcare-Jefferson Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,111
Cash Discount Price: $3,443
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Tennova Healthcare-Jefferson Memorial Hospital is $1,111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,443. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.91x the Medicare baseline. Located in 110 Hospital Drive, Jefferson City, TN.

Cash / Self-Pay

$3,443

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,111

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: $3,443 (282%)

Insurance Median: $1,111 (91%)

Cash: $3,443 (282% of Medicare)

Ins. Median: $1,111 (91% 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
Veterans Eval Services	$378	31%
Medicaid / KanCare	$644	53%
UnitedHealthcare	$644 - $15,560	53%
Bluecare	$663 - $988	54%
Amerigroup	$683	56%
Tricare	$1,031	84%
Humana	$1,068	87%
Medicare (plans)	$1,068	87%
Node Bluecare Plus Tn Mcr Adv	$1,086	89%
Node Champva	$1,086	89%
Node Hospice Non Par Agree	$1,086	89%
Node Va	$1,086	89%
Node Devoted Health Mcr Adv	$1,090	89%
Node Farm Bureau Mcr Adv	$1,090	89%
Aetna	$1,100 - $9,990	90%
Blue Cross Blue Shield	$1,100 - $3,159	90%
Node Healthspring Mcr Adv	$1,100	90%
Node Amerigroup Mcr Adv	$1,122	92%
Node Wellcare Mcr Adv	$1,129	92%
Node Nhc Mcr Adv	$1,175	96%
Node Us Dept Of Labor	$1,357	111%
Three Rivers Work Comp Tn	$1,415	116%
Novanet Work Comp Tn	$1,751	143%
Occunet Work Comp Tn	$1,769	145%
Tn Work Comp	$1,769	145%
Ambetter / Centene	$2,009	164%
Point Comfort Underwriters	$2,350	192%
Cigna	$2,518	206%
Self Pay	$3,443	282%
Multiplan Complementary	$12,292	1005%

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 $3,443.
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 Tennova Healthcare-Jefferson 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.