CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Inova Fair Oaks Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,002
Cash Discount Price: $1,444
vs. Medicare Baseline: 2.11x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Inova Fair Oaks Hospital is $2,002. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,444. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.11x the Medicare baseline. Located in 3600 Joseph Siewick Drive, Fairfax, VA.

Cash / Self-Pay

$1,444

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,002

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: $1,444 (152%)

Insurance Median: $2,002 (211%)

Cash: $1,444 (152% of Medicare)

Ins. Median: $2,002 (211% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 211% of the Medicare baseline (a markup of 111%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$912 - $3,645	96%
Blue Cross Blue Shield	$912 - $2,466	96%
United	$912 - $2,857	96%
Sentara Health	$930 - $2,431	98%
Cigna	$948 - $1,864	100%
Kaiser	$948 - $2,252	100%
Humana	$1,003 - $1,495	106%
Innovation	$2,149 - $2,589	226%
Carefirst	$2,485 - $2,510	262%

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 $1,444.
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 Inova Fair Oaks Hospital 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.