CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Rolling Plains Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,804
Cash Discount Price: $2,278
vs. Medicare Baseline: 2.95x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Rolling Plains Memorial Hospital is $2,804. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,278. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.95x the Medicare baseline. Located in 200 E Arizona, Sweetwater, TX.

Cash / Self-Pay

$2,278

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,804

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: $2,278 (240%)

Insurance Median: $2,804 (295%)

Cash: $2,278 (240% of Medicare)

Ins. Median: $2,804 (295% 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 295% of the Medicare baseline (a markup of 195%). 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
Humana	$2,454	258%
UnitedHealthcare	$2,650	279%
Blue Cross Blue Shield	$2,804	295%
Cigna	$2,825	297%
Aetna	$2,979	314%

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 $2,278.
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 Rolling Plains Memorial 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.