CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Physicians Regional Medical Center

Billing Code: 45378 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$963

about 1.0× the $950 Medicare rate · typically $661–$981

modeled estimate · not a bill or quote

What this hospital charges insurers

$998

About the fair price

about $35 over the fair price · 1.1× Medicare

Medicare pays $950 Fair price $963 This hospital $998 Cash price $2,928 Hospital's list price $13,169

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 $166 Priciest $998

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

A fair price for a Colonoscopy (diagnostic) is about $963 (about 1.0× the $950 Medicare rate). Physicians Regional Medical Center charges insurers about $998, or about $2,928 in cash — about the fair price. Located in Powell, 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	$696 - $14,030	73%
Blue Cross Blue Shieldmajor	$855 - $2,722	90%
Aetnamajor	$855 - $1,920	90%
Cignamajor	$1,914 - $1,946	201%
Humanamajor	$830	87%
Ambetter (Centene)	$1,561	164%
Amerigroup	$518 - $872	55%
Cigna HealthSpring	$855	90%
Devoted Health	$847	89%
WellCare	$877	92%
+ 7 smaller / regional plans	$830 - $1,561

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 4 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 2,928), 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: 45378.

Insurance Before you use insurance

Call your insurance company to confirm Physicians Regional Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 45378.
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 Physicians Regional Medical Center

Compare: Colonoscopy (diagnostic) at other TN hospitals

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