CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: HCA Houston Healthcare Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,092
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.20x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at HCA Houston Healthcare Medical Center is $2,092. 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 $950.1, this hospital’s rate is 2.20x the Medicare baseline. Located in 1313 Hermann Dr, Houston, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,092

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%)

Insurance Median: $2,092 (220%)

Ins. Median: $2,092 (220% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 220% of the Medicare baseline (a markup of 120%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
United	$352 - $2,900	37%
Molina Healthcare	$361	38%
Community Health Choice Mcd	$368	39%
Humana	$411 - $4,690	43%
Aetna	$415 - $3,106	44%
Superior Health Plan	$948	100%
Blue Cross Blue Shield	$1,566 - $2,085	165%
Evry Health	$2,431	256%
Healthcare Highways	$2,434	256%
Curative Administrators	$2,613	275%
Cigna	$2,915 - $3,755	307%
Oscar	$2,979	314%

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: 45378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm HCA Houston Healthcare Medical Center 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.