CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Princeton Community Hospital Assn Inc

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $511
Cash Discount Price: $1,652
vs. Medicare Baseline: 0.54x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Princeton Community Hospital Assn Inc is $511. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,652. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.54x the Medicare baseline. Located in 122 12Th Street, Princeton, WV.

Cash / Self-Pay

$1,652

Average discount available for prompt cash payment at this facility.

Insurance Median

$511

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: $1,652 (174%)

Insurance Median: $511 (54%)

Cash: $1,652 (174% of Medicare)

Ins. Median: $511 (54% 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
Highmark Health Options West Va	$105	11%
Wellpoint West Virginia	$105	11%
The Health Plan Wv	$106	11%
Aetna	$107 - $998	11%
Medicaid / KanCare	$180	19%
Pennsylvania Health & Wellness	$180	19%
Blue Cross Blue Shield	$475 - $5,130	50%
Medicare (plans)	$475 - $1,008	50%
Humana	$499 - $998	53%
UnitedHealthcare	$518 - $1,036	55%

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 $1,652.
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 Princeton Community Hospital Assn Inc 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.