CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Medical Center Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $981
Cash Discount Price: $1,539
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Medical Center Hospital is $981. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,539. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.03x the Medicare baseline. Located in 500 W 4Th Street, Odessa, TX.

Cash / Self-Pay

$1,539

Average discount available for prompt cash payment at this facility.

Insurance Median

$981

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: $1,539 (162%)

Insurance Median: $981 (103%)

Cash: $1,539 (162% of Medicare)

Ins. Median: $981 (103% 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
Corvel Wc	$276 - $328	29%
Ambetter / Centene	$299 - $965	31%
Amerigroup	$299	31%
Blue Cross Blue Shield	$299 - $1,344	31%
Community Health Choice	$299	31%
First Care Health Plan	$299	31%
Superior Health Plan	$299	31%
UnitedHealthcare	$299 - $1,403	31%
Medicaid / KanCare	$346 - $363	36%
Superior Chips	$346	36%
Cigna	$433 - $1,742	46%
Geha	$759 - $1,403	80%
Aetna	$842 - $1,962	89%
Humana	$856	90%
Novitas Solutions	$919	97%
Triwest Va Ccn	$919	97%
Health Select	$932 - $1,034	98%
Care Improvement Plus	$934	98%
Wellcare By Allwell	$965	102%
Firstcare	$981	103%
Group Resources	$1,121	118%
90 Degree Benefits	$1,154	121%
State Comptroller	$1,202	127%
Caprock	$1,357 - $1,580	143%
Healthsmart Preferred Care	$1,443 - $1,590	152%
Texas Mutual Wc	$1,587	167%
Workers Comp	$1,868	197%

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 $1,539.
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 Medical Center 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.