CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,812
Cash Discount Price: $1,131
vs. Medicare Baseline: 1.91x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Carilion Stonewall Jackson Hospital is $1,812. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,131. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.91x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.

Cash / Self-Pay

$1,131

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,812

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: $1,131 (119%)

Insurance Median: $1,812 (191%)

Cash: $1,131 (119% of Medicare)

Ins. Median: $1,812 (191% 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
Humana	$96 - $886	10%
Blue Cross Blue Shield	$304 - $4,340	32%
Sentara Health Plan	$310 - $2,003	33%
Abh of VA (Formerly Coventry)	$319	34%
Abh of Wva (Formerly Coventry)	$319	34%
UnitedHealthcare	$319 - $2,641	34%
Aetna	$816 - $2,145	86%
Gateway - Tier 3	$1,777	187%
Vhn - Ultra	$2,003	211%
Connecticare	$2,262	238%
Gateway - Tier 2	$2,585	272%
Vhn - Plus	$2,585	272%
Cigna	$2,588	272%
Integrated Health Plan	$2,746	289%
Vhn	$2,746	289%
Vhn - Link	$2,908	306%
Beech Street	$2,973	313%
Gateway - Tier 1	$3,069	323%
Vhn - Secondary Payors	$3,069	323%

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 $1,131.
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 Carilion Stonewall Jackson 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.