CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Physicians Regional Medical Center

Billing Code: 45380 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,153

about 0.9× the $1,223 Medicare rate · typically $824–$1,215

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,100

About the fair price

about $53 under the fair price · 0.9× Medicare

Medicare pays $1,223 Fair price $1,153 This hospital $1,100 Cash price $3,688 Hospital's list price $16,608

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 $1,100

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

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Colonoscopy with biopsy is about $1,153 (about 0.9× the $1,223 Medicare rate). Physicians Regional Medical Center charges insurers about $1,100, or about $3,688 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 - $16,705	57%
Blue Cross Blue Shieldmajor	$865 - $3,241	71%
Aetnamajor	$1,100 - $1,920	90%
Cignamajor	$2,476 - $2,504	203%
Humanamajor	$1,068	87%
Ambetter (Centene)	$2,009	164%
Amerigroup	$683 - $1,122	56%
Cigna HealthSpring	$1,100	90%
Devoted Health	$1,090	89%
WellCare	$1,129	92%
+ 7 smaller / regional plans	$1,068 - $2,009

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 3,688), 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 Physicians Regional 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 Physicians Regional Medical Center

Compare: Colonoscopy with biopsy at other TN hospitals

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