CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Christus St Michael Health System

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,158
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.95x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Christus St Michael Health System is $1,158. 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 0.95x the Medicare baseline. Located in 2600 St Michael Dr, Texarkana, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,158

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: $1,158 (95%)

Ins. Median: $1,158 (95% 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
Arkansas Total Care	$250	20%
Empower Healthcare Solutions	$255	21%
UnitedHealthcare	$361 - $4,537	30%
Amerigroup	$429 - $1,250	35%
Superior	$429	35%
Texas True Choice	$429	35%
Summit Community Care	$438	36%
Molina	$451 - $1,158	37%
Texas Children'S Health Plan	$451	37%
Blue Cross Blue Shield	$1,095 - $2,661	90%
Aetna	$1,158 - $5,706	95%
Christus Health	$1,158 - $1,620	95%
Coventry	$1,158	95%
Humana	$1,158 - $2,042	95%
Texas Healthspring	$1,158	95%
Triwest	$1,158	95%
Windsor	$1,158	95%
Provider Partners Health Plan	$1,192	98%
Texas Independence Health Plan	$1,192	98%
Shared Health Insurance Company	$1,215	99%
Tribute Health Plan	$1,215	99%
Us Imaging Network	$1,239	101%
Imperial Health Plan	$1,273	104%
Medicare (plans)	$1,273	104%
Procare Advantage	$1,273	104%
State Of Oklahoma	$1,330	109%
Naphcare Inc.	$2,315	189%
Qualchoice	$3,584	293%
Healthcare Highways	$4,259	348%
Five Point Credit Union	$4,650	380%
Cigna	$6,367	521%

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 Christus St Michael Health System 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.