CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Tops Surgical Specialty Hospital

Billing Code: 45380 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,398

about 1.1× the $1,223 Medicare rate · typically $940–$1,787

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,349

About the fair price

about $49 under the fair price · 1.1× Medicare

Medicare pays $1,223 Fair price $1,398 This hospital $1,349 Cash price $474 Hospital's list price $1,354

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 $1,349

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 $1,398 (about 1.1× the $1,223 Medicare rate). Tops Surgical Specialty Hospital charges insurers about $1,349, or about $474 in cash — about the fair price. Located in Houston, 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	$394 - $2,571	32%
Blue Cross Blue Shieldmajor	$609 - $1,985	50%
Aetnamajor	$1,317 - $3,378	108%
Cignamajor	$4,016 - $5,394	328%
Humanamajor	$655 - $2,628	54%
Ambetter (Centene)	$280 - $2,473	23%
Health Net	$702 - $1,151	57%
Oscar Health	$245 - $1,530	20%

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 474), 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 Tops Surgical Specialty Hospital 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 (%)

Enter your details and press estimate to compare.

Other Procedures at Tops Surgical Specialty Hospital

Compare: Colonoscopy with biopsy at other TX hospitals

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