CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Harlingen Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,196
Cash Discount Price: $1,196
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Harlingen Medical Center is $1,196. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,196. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.98x the Medicare baseline. Located in 5501 South Expressway 77, Harlingen, TX.

Cash / Self-Pay

$1,196

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,196

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%)

Cash / Self-Pay: $1,196 (98%)

Insurance Median: $1,196 (98%)

Cash: $1,196 (98% of Medicare)

Ins. Median: $1,196 (98% 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
Aetna	$1,161 - $1,196	95%
Blue Cross Blue Shield	$1,196 - $1,436	98%
Careworks Worker Compensation Fka Rockport Community Network	$1,196	98%
Cigna	$1,196 - $1,232	98%
Humana	$1,196	98%
Medicare (plans)	$1,196	98%
San Benito Medical Associates	$1,196	98%
Superior Health Plan	$1,196	98%
Texas Bluebonnett Health Plan	$1,196 - $1,974	98%
Tricare	$1,196	98%
UnitedHealthcare	$1,196 - $2,997	98%
Veterans Evaluation Services	$1,196	98%
Wellmed	$1,196	98%
Workers Compensation	$1,196	98%
Molina	$1,256 - $1,854	103%
Provider Partners Health Plan	$1,256	103%
Imperial Insurance Company	$1,268	104%
Asserta Health	$1,555	127%
Friday Health Plan	$1,555	127%
Magic Valley Electric Cooperative	$1,555	127%
Superior Health Commercial Exchange	$1,555	127%
Employer Direct Healthcare	$1,675	137%
Corporate Remedies Worker Compensation	$1,794	147%
Naphcare	$1,854	152%
Baker Benefits Administrators	$2,392	196%

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 $1,196.
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 Harlingen 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.