CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Ward Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $665
Cash Discount Price: $1,475
vs. Medicare Baseline: 0.54x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Ward Memorial Hospital is $665. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,475. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.54x the Medicare baseline. Located in 406 South Gary St, Monahans, TX.

Cash / Self-Pay

$1,475

Average discount available for prompt cash payment at this facility.

Insurance Median

$665

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: $1,475 (121%)

Insurance Median: $665 (54%)

Cash: $1,475 (121% of Medicare)

Ins. Median: $665 (54% 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
Blue Cross Blue Shield	$136 - $2,450	11%
Firstcare	$136 - $678	11%
Medicare (plans)	$136 - $665	11%
Superior Healthplan	$136 - $665	11%
Cigna	$418 - $2,044	34%
Corecare	$500 - $2,450	41%
Texas True Choice	$536 - $2,625	44%
Unicare	$572 - $2,800	47%
Galaxy Health Network	$644 - $3,150	53%
Multiplan	$644 - $3,150	53%
Usa Health Network	$644 - $3,150	53%
Usc Health Services	$644 - $3,150	53%
Aetna	$708 - $3,465	58%

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 $1,475.
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 Ward Memorial Hospital 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.