CMS Price Transparency Data

Colonoscopy with biopsy

Facility: North Texas Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,124
Cash Discount Price: $953
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at North Texas Medical Center is $1,124. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $953. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.92x the Medicare baseline. Located in 1900 Hospital Blvd, Gainesville, TX.

Cash / Self-Pay

$953

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,124

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: $953 (78%)

Insurance Median: $1,124 (92%)

Cash: $953 (78% of Medicare)

Ins. Median: $1,124 (92% 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
Cigna	$278 - $2,769	23%
Blue Cross Blue Shield	$348 - $3,461	28%
First Health	$417 - $4,153	34%
Healthcare Highways	$417 - $4,153	34%
Aetna	$431 - $4,292	35%
Multiplan	$486 - $4,845	40%
Provider Select	$591 - $5,884	48%
Prime Health	$626 - $6,230	51%
UnitedHealthcare	$639 - $6,368	52%
90 Degree Benefits	$1,124	92%
Humana	$1,124	92%
Molina	$1,124 - $1,237	92%
Prominence Health	$1,124 - $1,181	92%
Superior	$1,124 - $1,237	92%
Wellmed	$1,124	92%
Wellpoint	$1,124	92%
Providers Partners Health Plan	$1,181	97%

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 $953.
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 North Texas 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.