CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Caromont Regional Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $998
Cash Discount Price: $3,732
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Caromont Regional Medical Center is $998. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,732. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.05x the Medicare baseline. Located in 2525 Court Dr, Gastonia, NC.

Cash / Self-Pay

$3,732

Average discount available for prompt cash payment at this facility.

Insurance Median

$998

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$950.1

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $950.1 (100%)

Cash / Self-Pay: $3,732 (393%)

Insurance Median: $998 (105%)

Cash: $3,732 (393% of Medicare)

Ins. Median: $998 (105% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $950.1 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
Blue Cross Blue Shield	$517 - $1,581	54%
Carolina Complete Health	$517 - $606	54%
Partners Behavioral Health	$517 - $606	54%
Alliance Behavioral Health	$528 - $618	56%
Amerihealth Caritas	$528 - $618	56%
Carolina Complete Health Tailored Plans	$528 - $618	56%
UnitedHealthcare	$528 - $1,041	56%
Vaya Behavioral Health	$528 - $618	56%
Wellcare	$528 - $618	56%
Aetna	$715 - $988	75%
Absolute Total Care	$780	82%
Molina	$780 - $998	82%
Devoted Health	$998	105%
Healthteam	$998	105%
Longevity Health	$998	105%
Humana	$1,017 - $3,544	107%
Gaston County Jail	$1,035 - $1,212	109%
Kintegra Health	$1,200	126%
Surgery Plus	$1,663	175%
Cigna	$1,767 - $2,478	186%
Medcost	$1,937 - $2,337	204%
Self Pay	$2,234 - $2,618	235%
Carolina Caring	$2,375 - $3,189	250%
Corporate Benefits Service	$2,556	269%
Beech Street	$2,818 - $3,302	297%
Multiplan	$2,818 - $3,302	297%
First Health Network	$3,265 - $3,826	344%

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 $3,732.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Caromont Regional Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45378.
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.