CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Yoakum County Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $568
Cash Discount Price: $1,401
vs. Medicare Baseline: 0.60x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Yoakum County Hospital is $568. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,401. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.60x the Medicare baseline. Located in 412 Mustang Avenue, Denver City, TX.

Cash / Self-Pay

$1,401

Average discount available for prompt cash payment at this facility.

Insurance Median

$568

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%)

Cash / Self-Pay: $1,401 (147%)

Insurance Median: $568 (60%)

Cash: $1,401 (147% of Medicare)

Ins. Median: $568 (60% 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
Healthsmart	$129 - $1,888	14%
Aetna	$167 - $1,899	18%
Humana	$180 - $1,453	19%
UnitedHealthcare	$180 - $1,788	19%
90 Degree Benefits	$193 - $284	20%
Cigna	$369 - $1,453	39%
Insurance Services Of Lubbock	$369 - $2,400	39%
Firstcare	$375 - $1,564	39%
Multiplan	$375 - $1,955	39%
Dars	$397 - $1,564	42%
Phcs	$482 - $1,899	51%
Capstar	$511 - $2,011	54%
Provider Network	$553 - $2,179	58%
Blue Cross Blue Shield	$568 - $2,235	60%

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 $1,401.
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 Yoakum County 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.