CMS Price Transparency Data

Colonoscopy with biopsy

Facility: UT Health East Texas Carthage Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,259
Cash Discount Price: $504
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at UT Health East Texas Carthage Hospital is $1,259. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $504. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.03x the Medicare baseline. Located in 409 Cottage Rd, Carthage, TX.

Cash / Self-Pay

$504

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,259

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: $504 (41%)

Insurance Median: $1,259 (103%)

Cash: $504 (41% of Medicare)

Ins. Median: $1,259 (103% 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
Amerigroup Commercial [5055]	$1,259	103%
Black Lung [6055]	$1,259	103%
Healthcare Highways [2210]	$1,259	103%
Healthscope Benefits [2290]	$1,259	103%
Lucent Health [6000]	$1,259	103%
Medicaid / KanCare	$1,259	103%
Parkland Community Health Plan [6015]	$1,259	103%
Web Tpa [2115]	$1,259 - $3,077	103%
Cigna	$2,810	230%
Aetna	$3,077	252%
Mailhandlers [1595]	$3,077	252%

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 $504.
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 UT Health East Texas Carthage 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.