CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Caromont Regional Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,284
Cash Discount Price: $4,116
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Caromont Regional Medical Center is $1,284. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,116. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.05x the Medicare baseline. Located in 2525 Court Dr, Gastonia, NC.

Cash / Self-Pay

$4,116

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,284

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: $4,116 (337%)

Insurance Median: $1,284 (105%)

Cash: $4,116 (337% of Medicare)

Ins. Median: $1,284 (105% 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
Blue Cross Blue Shield	$504 - $1,541	41%
Carolina Complete Health	$504 - $734	41%
Partners Behavioral Health	$504 - $734	41%
Alliance Behavioral Health	$514 - $749	42%
Amerihealth Caritas	$514 - $749	42%
Carolina Complete Health Tailored Plans	$514 - $749	42%
UnitedHealthcare	$514 - $1,223	42%
Vaya Behavioral Health	$514 - $749	42%
Wellcare	$514 - $749	42%
Aetna	$697 - $1,271	57%
Absolute Total Care	$780	64%
Molina	$780 - $1,284	64%
Gaston County Jail	$1,009 - $1,469	83%
Kintegra Health	$1,200	98%
Devoted Health	$1,284	105%
Healthteam	$1,284	105%
Longevity Health	$1,284	105%
Humana	$1,308 - $4,294	107%
Surgery Plus	$2,139	175%
Self Pay	$2,178 - $3,172	178%
Cigna	$2,274 - $2,440	186%
Medcost	$2,279 - $2,347	186%
Carolina Caring	$2,654 - $3,865	217%
Beech Street	$2,748 - $4,002	225%
Multiplan	$2,748 - $4,002	225%
First Health Network	$3,183 - $4,636	260%
Corporate Benefits Service	$3,289	269%

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 $4,116.
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 Caromont Regional Medical Center 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.