CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Texas Orthopedic Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,661
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.75x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Texas Orthopedic Hospital is $1,661. 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 1.75x the Medicare baseline. Located in 7401 South Main Street, Houston, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,661

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: $1,661 (175%)

Ins. Median: $1,661 (175% 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.

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
Texas Health Network	$322	34%
Amerigroup	$345	36%
United	$352 - $3,400	37%
Molina Healthcare	$361	38%
Community Health Choice Mcd	$368	39%
Humana	$411 - $4,690	43%
Aetna	$415 - $3,689	44%
Wellmed	$939	99%
Superior Health Plan	$948	100%
Blue Cross Blue Shield	$1,360 - $2,085	143%
Fidelis Securecare Of Tx	$2,115	223%
Evry Health	$2,431	256%
Healthcare Highways	$2,434	256%
Curative Administrators	$2,613	275%
Oscar	$2,979	314%
Cigna	$3,099 - $3,993	326%

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 Texas Orthopedic Hospital 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.