CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Christus Santa Rosa Hospital-San Marcos

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,171
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Christus Santa Rosa Hospital-San Marcos is $1,171. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.96x the Medicare baseline. Located in 1301 Wonder World Drive, San Marcos, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,171

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%)

Insurance Median: $1,171 (96%)

Ins. Median: $1,171 (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
UnitedHealthcare	$375 - $4,331	31%
Community First	$429	35%
Blue Cross Blue Shield	$438 - $2,521	36%
Amerigroup	$451 - $1,234	37%
Texas Childrens Health Plan	$451	37%
Superior	$494	40%
Allwell	$1,143	93%
Christus Health	$1,143 - $1,600	93%
Humana	$1,143 - $6,561	93%
Triwest	$1,143	93%
Washington National	$1,143	93%
Wellcare	$1,143	93%
Aetna	$1,166	95%
Cigna	$1,177 - $6,603	96%
Provider Partners Health Plan	$1,177	96%
Shared Health Insurance Company	$1,200	98%
Devoted Health Plan	$1,234	101%
Sendero	$1,954	160%
Naphcare Inc.	$2,285	187%
Healthcare Highways	$2,891	236%
Five Point Credit Union	$4,020	329%

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 $X.
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 Christus Santa Rosa Hospital-San Marcos 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.