CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Carolinas Medical Center/Behav Health

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $558
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.46x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Carolinas Medical Center/Behav Health is $558. 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 $1,222.56, this hospital’s rate is 0.46x the Medicare baseline. Located in 1000 Blythe Blvd, Charlotte, NC.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$558

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%)

Insurance Median: $558 (46%)

Ins. Median: $558 (46% 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	$183 - $714	15%
Cigna	$183 - $1,238	15%
Humana	$187 - $1,203	15%
Aetna	$189 - $1,220	15%
UnitedHealthcare	$190 - $1,242	16%
Partners	$201	16%
Amerihealth Caritas	$203	17%
Carolina Complete Health	$203	17%
Healthy Blue	$203	17%
Trillium	$203	17%
Vaya	$203	17%
Wellcare	$203	17%
Alliance	$205	17%
Ortho Carolina	$229 - $1,474	19%
Employers Health Network	$464	38%
Medcost	$519	42%
Choicecare	$573	47%
Molina	$879	72%

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: 45380.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Carolinas Medical Center/Behav Health 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.