CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Madison St Joseph Health Center

Billing Code: 45380 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$849

about 0.7× the $1,223 Medicare rate · typically $213–$1,811

modeled estimate · not a bill or quote

What this hospital charges insurers

$367

Below the fair price — a good deal

about $482 under the fair price · 0.3× Medicare

Medicare pays $1,223 Fair price $849 This hospital $367 Cash price $97 Hospital's list price $556

How we calculate the fair BaseRate →

How this hospital compares to other TX hospitals

Highest price of the 9 TX hospitals we have prices for — worth calling around.

Cheapest $174 Priciest $367

Black dot = this hospital, among the 9 TX hospitals with a price for this procedure. Full list below.

A fair price for a Colonoscopy with biopsy is about $849 (about 0.7× the $1,223 Medicare rate). Madison St Joseph Health Center charges insurers about $367, or about $97 in cash — below the fair price — a good deal. Located in Madisonville, TX.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$74 - $4,168	6%
Blue Cross Blue Shieldmajor	$72 - $1,657	6%
Aetnamajor	$72 - $367	6%
Cignamajor	$356 - $3,346	29%
Humanamajor	$339	28%
Ambetter (Centene)	$105	9%
Bright Health	$208	17%
+ 7 smaller / regional plans	$74 - $1,120

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 97), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 45380.

Insurance Before you use insurance

Call your insurance company to confirm Madison St Joseph Health Center is in-network.
Ask your insurer whether prior approval is required for CPT code 45380.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Madison St Joseph Health Center

Compare: Colonoscopy with biopsy at other TX hospitals

Insurance negotiated median for the same procedure, sorted lowest first.