CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Johnson City Medical Center

Billing Code: 45380 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,109

about 0.9× the $1,223 Medicare rate · typically $1,030–$1,207

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,172

About the fair price

about $63 over the fair price · 1.0× Medicare

Medicare pays $1,223 Fair price $1,109 This hospital $1,172 Cash price $484 Hospital's list price $3,227

How we calculate the fair BaseRate →

How this hospital compares to other TN hospitals

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

Cheapest $258 Priciest $1,172

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

A fair price for a Colonoscopy with biopsy is about $1,109 (about 0.9× the $1,223 Medicare rate). Johnson City Medical Center charges insurers about $1,172, or about $484 in cash — about the fair price. Located in Johnson City, TN.

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	$1,083 - $2,397	89%
Blue Cross Blue Shieldmajor	$775 - $2,521	63%
Aetnamajor	$1,117 - $2,059	91%
Cignamajor	$1,172 - $1,956	96%
Humanamajor	$1,117	91%
Ambetter (Centene)	$2,434	199%
Amerigroup	$889 - $1,117	73%
Devoted Health	$1,172	96%
Molina	$1,161 - $1,317	95%
Sentara	$1,117 - $1,267	91%
WellCare	$1,184 - $3,227	97%
+ 4 smaller / regional plans	$1,117 - $3,227

Government programs also on file: Medicare.

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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 484), 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 Johnson City 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 Johnson City Medical Center

Compare: Colonoscopy with biopsy at other TN hospitals

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