CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Johnson City Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,172
Cash Discount Price: $484
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Johnson City Medical Center is $1,172. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $484. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.96x the Medicare baseline. Located in 400 N State of Franklin Rd, Johnson City, TN.

Cash / Self-Pay

$484

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,172

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: $484 (40%)

Insurance Median: $1,172 (96%)

Cash: $484 (40% of Medicare)

Ins. Median: $1,172 (96% 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
Blue Cross Blue Shield	$775 - $2,521	63%
Amerigroup	$889 - $1,117	73%
UnitedHealthcare	$1,083 - $2,397	89%
Aetna	$1,117 - $2,059	91%
Humana	$1,117	91%
Managed Medicaire	$1,117	91%
Medicare (plans)	$1,117	91%
Mountain Empire Pace	$1,117	91%
Sentara Health	$1,117 - $1,126	91%
United Mine Workers Of America	$1,117	91%
Medcost	$1,129	92%
Molina Healthcare	$1,161 - $1,317	95%
Cigna	$1,172 - $1,956	96%
Devoted Health Plan	$1,172	96%
Nhc Advantage	$1,172	96%
Wellcare	$1,184 - $3,227	97%
Optima Health	$1,267	104%
First Health Coventry	$2,420	198%
Ambetter / Centene	$2,434	199%
Seven Corners, Inc.	$3,227	264%

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 $484.
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 Johnson City Medical Center 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.