CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Carolina East Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,327
Cash Discount Price: $1,335
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Carolina East Medical Center is $1,327. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,335. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.09x the Medicare baseline. Located in 2000 Neuse Blvd, New Bern, NC.

Cash / Self-Pay

$1,335

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,327

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: $1,335 (109%)

Insurance Median: $1,327 (109%)

Cash: $1,335 (109% of Medicare)

Ins. Median: $1,327 (109% 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
Humana	$169 - $1,144	14%
Inclusive Health (Nchirp)-All Plans	$169 - $1,144	14%
Tricare	$169 - $2,950	14%
Pamlico Co Jail-All Plans	$399 - $785	33%
Craven Co. Jail Systems - All Plans	$403 - $994	33%
UnitedHealthcare	$525 - $2,097	43%
Medcost Ppo Employees And Retirees	$985 - $1,937	81%
Medcost Ppo Ultra (Employees)	$985 - $1,846	81%
Blue Cross Blue Shield	$1,047 - $2,023	86%
Medcost Ppo City Employees	$1,093 - $2,149	89%
Medcost Ppo County Employee	$1,136 - $2,235	93%
Benefit Mgmt, Svcs-All Plans	$1,275 - $2,508	104%
Medcost Benefit Svc-All Other Plans	$1,326 - $2,607	108%
Aetna	$1,329 - $2,614	109%
Acs Consult Svc Inc-All Plans	$1,355 - $2,664	111%
Medcost Ppo Standard	$1,355 - $2,664	111%
Cigna	$1,365 - $2,684	112%

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 $1,335.
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 Carolina East 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.