CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Charleston Area Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,234
Cash Discount Price: $1,999
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Charleston Area Medical Center is $1,234. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,999. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.01x the Medicare baseline. Located in 501 Morris Street, Charleston, WV.

Cash / Self-Pay

$1,999

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,234

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: $1,999 (164%)

Insurance Median: $1,234 (101%)

Cash: $1,999 (164% of Medicare)

Ins. Median: $1,234 (101% 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
Aetna	$151 - $2,016	12%
The Health Plan Of West Virginia Inc.	$151 - $1,995	12%
Unicare Health Plan Of West Virginia Inc.	$151 - $312	12%
Choicecare Network	$229 - $2,016	19%
Blue Cross Blue Shield	$252 - $1,876	21%
Tricare	$348 - $1,234	28%
Triwest Va	$427 - $1,186	35%
Optimum Choice Inc.	$440 - $1,223	36%
UnitedHealthcare	$440 - $2,016	36%
West Virginia Senior Advantage Inc.	$462 - $1,284	38%
Integrated Medical Solutions	$522 - $1,851	43%
Three Rivers Providers Network	$563 - $1,995	46%
Healthsmart	$568 - $2,016	46%
Multiplan	$568 - $2,016	46%
City Of Charleston	$573 - $1,543	47%
Cigna	$574 - $1,913	47%
Caresource	$580 - $2,057	47%
Naphcare	$580 - $2,057	47%

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 $1,999.
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 Charleston Area 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.