CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Baylor Scott and White Medical Center Lake Pointe

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,241
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Baylor Scott and White Medical Center Lake Pointe is $1,241. 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 1.02x the Medicare baseline. Located in 6800 Scenic Dr, Rowlett, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,241

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: $1,241 (102%)

Ins. Median: $1,241 (102% 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
Superior Health Plan	$429 - $1,133	35%
Wellpoint (Fka Amerigroup)	$429 - $1,112	35%
Baylor Scott & White Health Plan	$1,025 - $1,781	84%
Humana	$1,079	88%
Triwest	$1,079	88%
Corvel	$1,131	93%
Prime Health Services	$1,131	93%
American Health Plan	$1,133	93%
Blue Cross Blue Shield	$1,133 - $2,501	93%
Healthspring	$1,133	93%
Molina	$1,133	93%
Procare Advantage	$1,133	93%
UnitedHealthcare	$1,241 - $2,846	102%
Ambetter / Centene	$2,234	183%
Healthsmart	$3,417	279%
Cigna	$3,779 - $4,446	309%
Aetna	$5,016	410%

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 Baylor Scott and White Medical Center Lake Pointe 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.