CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Charleston Area Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,057
Cash Discount Price: $1,711
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Charleston Area Medical Center is $1,057. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,711. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.11x the Medicare baseline. Located in 501 Morris Street, Charleston, WV.

Cash / Self-Pay

$1,711

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,057

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: $1,711 (180%)

Insurance Median: $1,057 (111%)

Cash: $1,711 (180% of Medicare)

Ins. Median: $1,057 (111% 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
Aetna	$138 - $1,726	15%
The Health Plan Of West Virginia Inc.	$138 - $1,708	15%
Unicare Health Plan Of West Virginia Inc.	$138 - $242	15%
Choicecare Network	$211 - $1,726	22%
Blue Cross Blue Shield	$233 - $1,606	25%
Triwest Va	$340 - $922	36%
Optimum Choice Inc.	$350 - $950	37%
UnitedHealthcare	$350 - $1,726	37%
West Virginia Senior Advantage Inc.	$368 - $998	39%
City Of Charleston	$455 - $1,321	48%
Naphcare	$480 - $1,761	51%
Integrated Medical Solutions	$508 - $1,585	53%
Caresource	$525 - $1,761	55%
Tricare	$680 - $1,057	72%
Three Rivers Providers Network	$1,099 - $1,708	116%
Healthsmart	$1,110 - $1,726	117%
Multiplan	$1,110 - $1,726	117%
Cigna	$1,122 - $1,638	118%

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 $1,711.
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 Charleston Area Medical Center 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.