CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Erlanger Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $469
Cash Discount Price: $475
vs. Medicare Baseline: 0.38x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Erlanger Medical Center is $469. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $475. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.38x the Medicare baseline. Located in 975 E 3Rd St, Chattanooga, TN.

Cash / Self-Pay

$475

Average discount available for prompt cash payment at this facility.

Insurance Median

$469

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: $475 (39%)

Insurance Median: $469 (38%)

Cash: $475 (39% of Medicare)

Ins. Median: $469 (38% 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
UnitedHealthcare	$186 - $2,871	15%
Amerigroup	$234 - $555	19%
Cigna	$249 - $1,082	20%
Alexian	$260 - $1,082	21%
Blue Cross Blue Shield	$260 - $1,901	21%
Bluecare	$260 - $1,125	21%
Clover	$260 - $1,082	21%
Humana	$260 - $1,082	21%
Medicare (plans)	$260	21%
Upmc	$260 - $1,082	21%
Aetna	$262 - $1,114	21%
Pruitthealth Premier	$267	22%
American Health	$268 - $1,114	22%
Devoted Health	$271 - $1,125	22%
Nhc	$273 - $1,136	22%
Atrio Health	$286 - $1,190	23%
Simpra Advantage	$286	23%
Caresource	$316 - $2,163	26%
Peach State Hlth Plan	$316	26%
Ambetter / Centene	$326 - $1,352	27%
Bluecard - Network S	$326 - $554	27%
Bluecard - Network P	$345 - $554	28%
Caresource Ga	$364 - $653	30%
Caresource Tn	$364 - $653	30%
Olympus	$391 - $443	32%
Alliant	$417 - $813	34%
Caresource Nc	$440 - $653	36%
Occunet	$456 - $1,028	37%
Point Comfort Underwriters	$457 - $469	37%
Pnoa	$521 - $2,704	43%
Wellpoint	$1,016	83%

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 $475.
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 Erlanger 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.