CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Lonesome Pine Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,273
Cash Discount Price: $484
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Lonesome Pine Hospital is $1,273. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $484. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.04x the Medicare baseline. Located in 1990 Holton Avenue East, Big Stone Gap, VA.

Cash / Self-Pay

$484

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,273

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: $484 (40%)

Insurance Median: $1,273 (104%)

Cash: $484 (40% of Medicare)

Ins. Median: $1,273 (104% 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	$697 - $1,861	57%
Sentara Health	$817 - $1,168	67%
Blue Cross Blue Shield	$948 - $3,227	78%
Aetna	$1,168 - $1,378	96%
Amerigroup	$1,168	96%
Humana	$1,168	96%
Managed Medicaire	$1,168	96%
Medicare (plans)	$1,168	96%
United Mine Workers Of America	$1,168	96%
Cigna	$1,226 - $2,588	100%
Devoted Health Plan	$1,226	100%
Molina Healthcare	$1,226 - $1,334	100%
Mountain Empire Pace	$1,226	100%
Nhc Advantage	$1,226	100%
Wellcare	$1,238	101%
Optima Health	$1,309	107%
Medcost	$1,536	126%
Ambetter / Centene	$2,545	208%
Seven Corners, Inc.	$2,802	229%
First Health Coventry	$2,904	238%

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 $484.
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 Lonesome Pine Hospital 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.