CMS Price Transparency Data

Colonoscopy with biopsy

Facility: St David's South Austin Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,613
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.14x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at St David's South Austin Medical Center is $2,613. 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 2.14x the Medicare baseline. Located in 901 West Ben White Blvd, Austin, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,613

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: $2,613 (214%)

Ins. Median: $2,613 (214% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 214% of the Medicare baseline (a markup of 114%). 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
Amerigroup	$254	21%
St David’S Hospice	$429	35%
Blue Cross Blue Shield	$451 - $2,601	37%
United	$461 - $5,947	38%
Molina Healthcare	$472	39%
Humana	$537	44%
Sendero	$537	44%
Aetna	$601 - $5,457	49%
Superior Health Plan	$929	76%
Nomi Health	$2,256 - $2,375	185%
Curative Administrators	$2,613	214%
Evry Health	$2,894	237%
Healthcare Highways	$3,097 - $3,160	253%
Harbor Health Team	$3,230	264%
Cigna	$3,375 - $4,304	276%
Moda Health	$3,385 - $3,453	277%
Oscar	$3,623 - $4,282	296%
Moda	$4,023	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 St David's South Austin Medical Center 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.