CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Lee County Community Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,364
Cash Discount Price: $475
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Lee County Community Hospital is $1,364. 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 1.12x the Medicare baseline. Located in 127 Health Care Drive, Pennington Gap, VA.

Cash / Self-Pay

$475

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,364

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: $1,364 (112%)

Cash: $475 (39% of Medicare)

Ins. Median: $1,364 (112% 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
Aetna	$454 - $2,065	37%
Ambetter / Centene	$454	37%
Amerigroup	$454 - $2,065	37%
Managed Medicaire	$454	37%
Medicare (plans)	$454	37%
Mountain Empire Pace	$454	37%
Sentara Health	$454 - $533	37%
United Mine Workers Of America	$454	37%
UnitedHealthcare	$454 - $2,065	37%
Humana	$462	38%
Blue Cross Blue Shield	$468 - $2,065	38%
Molina Healthcare	$472 - $1,888	39%
Cigna	$477 - $2,065	39%
Devoted Health Plan	$477	39%
Nhc Advantage	$477	39%
Seven Corners, Inc.	$1,090	89%
Optima Health	$1,815	148%
First Health Coventry	$2,065	169%
Medcost	$2,065	169%

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 Lee County Community 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.