CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Sweeny Community Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $164
Cash Discount Price: $656
vs. Medicare Baseline: 0.17x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Sweeny Community Hospital is $164. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $656. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.17x the Medicare baseline. Located in 305 North McKinney, Sweeny, TX.

Cash / Self-Pay

$656

Average discount available for prompt cash payment at this facility.

Insurance Median

$164

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: $656 (69%)

Insurance Median: $164 (17%)

Cash: $656 (69% of Medicare)

Ins. Median: $164 (17% 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
Amerigroup Mcr Adv - All Other Plans	$162	17%
Community Hlth Choice Him - All Other Plans	$162	17%
Coventry Mcr Adv	$162	17%
Molina Mcr Adv - All Other Plans	$162	17%
Superior Hp Mcr Adv-All Other Plans	$162	17%
UnitedHealthcare	$162	17%
Wellcare Mcare - All Plans	$162	17%
Care Improvement Mcr - All Plans	$164	17%
Choicecare Mcr Adv - All Plans	$164	17%
Amerigroup Mcaid	$1,093	115%
Community Hlth Choice Star	$1,093	115%
Evercare Mcaid	$1,093	115%
Molina Mcaid	$1,093	115%
Superior Hp Mcaid	$1,093	115%
Tx Chlidrens Hp Mcaid - All Plans	$1,093	115%
Tx True Choice Mcaid - All Plans	$1,093	115%

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 $656.
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 Sweeny Community 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.