CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Medical Center Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,179
Cash Discount Price: $1,329
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Medical Center Hospital is $1,179. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,329. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.96x the Medicare baseline. Located in 500 W 4Th Street, Odessa, TX.

Cash / Self-Pay

$1,329

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,179

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: $1,329 (109%)

Insurance Median: $1,179 (96%)

Cash: $1,329 (109% of Medicare)

Ins. Median: $1,179 (96% 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
Corvel Wc	$356 - $429	29%
UnitedHealthcare	$365 - $1,403	30%
Ambetter / Centene	$400 - $1,242	33%
Amerigroup	$400	33%
Blue Cross Blue Shield	$400 - $1,767	33%
Community Health Choice	$400	33%
First Care Health Plan	$400	33%
Superior Health Plan	$400	33%
Medicaid / KanCare	$452 - $474	37%
Superior Chips	$452	37%
Cigna	$564 - $1,742	46%
Aetna	$727 - $2,524	59%
Health Select	$893 - $1,225	73%
Firstcare	$981	80%
90 Degree Benefits	$996	81%
State Comptroller	$1,038	85%
Humana	$1,107	91%
Novitas Solutions	$1,183	97%
Triwest Va Ccn	$1,183	97%
Care Improvement Plus	$1,202	98%
Wellcare By Allwell	$1,242	102%
Healthsmart Preferred Care	$1,246 - $1,590	102%
Caprock	$1,357 - $1,580	111%
Texas Mutual Wc	$1,370	112%
Geha	$1,403	115%
Group Resources	$1,443	118%
Workers Comp	$2,404	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 $1,329.
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 Medical Center Hospital 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.