CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Johnson County Community Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 45380
  • Insurance Median: $1,028
  • Cash Discount Price: $475
  • vs. Medicare Baseline: 0.84x Medicare
The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Johnson County Community Hospital is $1,028. 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 0.84x the Medicare baseline. Located in 1901 S Shady St, Mountain City, TN.
Cash / Self-Pay
$475

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,028

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: $1,028 (84%)
Cash: $475 (39% of Medicare)
Ins. Median: $1,028 (84% 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.

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
Aetna $599 - $1,430 49%
Amerigroup $599 - $1,333 49%
Managed Medicaire $599 49%
Medicare (plans) $599 49%
Sentara Health $599 - $701 49%
United Mine Workers Of America $599 49%
UnitedHealthcare $599 - $2,065 49%
Wellcare $599 49%
Humana $608 50%
Blue Cross Blue Shield $617 - $2,065 50%
Molina Healthcare $623 - $1,430 51%
Cigna $629 - $1,956 51%
Devoted Health Plan $629 51%
Nhc Advantage $629 51%
Ambetter / Centene $661 54%
Medcost $723 59%
Optima Health $1,375 112%
First Health Coventry $1,549 127%
Seven Corners, Inc. $2,065 169%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1901 S Shady St, Mountain City, TN 37683
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals