CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Atrium Health Pineville

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $175
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.18x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Atrium Health Pineville is $175. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.18x the Medicare baseline. Located in 10628 Park Rd, Charlotte, NC.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$175

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%)

Insurance Median: $175 (18%)

Ins. Median: $175 (18% 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
Cigna	$84 - $910	9%
Humana	$86 - $884	9%
Aetna	$87 - $897	9%
UnitedHealthcare	$88 - $913	9%
Ortho Carolina	$106 - $1,084	11%
Trillium	$167	18%
Amerihealth Caritas	$169	18%
Carolina Complete Health	$169	18%
Healthy Blue	$169	18%
Partners	$169	18%
Vaya	$169	18%
Wellcare	$169	18%
Alliance	$170	18%
Blue Cross Blue Shield	$452 - $594	48%
Choicecare	$477	50%
Medcost	$477	50%

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 $X.
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 Atrium Health Pineville 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.