CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Texas Health Presbyterian Hospital Kaufman

Billing Code: 45380 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,200

about 1.0× the $1,223 Medicare rate · typically $1,026–$1,625

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,262

About the fair price

about $62 over the fair price · 1.0× Medicare

Medicare pays $1,223 Fair price $1,200 This hospital $1,262 Cash price $761 Hospital's list price $1,268

How we calculate the fair BaseRate →

How this hospital compares to other TX hospitals

Highest price of the 9 TX hospitals we have prices for — worth calling around.

Cheapest $174 Priciest $1,262

Black dot = this hospital, among the 9 TX hospitals with a price for this procedure. Full list below.

A fair price for a Colonoscopy with biopsy is about $1,200 (about 1.0× the $1,223 Medicare rate). Texas Health Presbyterian Hospital Kaufman charges insurers about $1,262, or about $761 in cash — about the fair price. Located in Kaufman, TX.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$429 - $3,751	35%
Blue Cross Blue Shieldmajor	$429 - $8,391	35%
Aetnamajor	$490 - $889	40%
Cignamajor	$701 - $1,193	57%
Humanamajor	$1,250	102%
Amerigroup	$429 - $1,262	35%
Cigna HealthSpring	$1,226	100%
Molina	$464 - $1,262	38%
WellCare	$451 - $1,322	37%
+ 6 smaller / regional plans	$429 - $2,319

Excludes 4 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 761), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 45380.

Insurance Before you use insurance

Call your insurance company to confirm Texas Health Presbyterian Hospital Kaufman is in-network.
Ask your insurer whether prior approval is required for CPT code 45380.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

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Other Procedures at Texas Health Presbyterian Hospital Kaufman

Compare: Colonoscopy with biopsy at other TX hospitals

Insurance negotiated median for the same procedure, sorted lowest first.