CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Coryell Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $5,877
Cash Discount Price: $3,812
vs. Medicare Baseline: 6.19x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Coryell Memorial Hospital is $5,877. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,812. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 6.19x the Medicare baseline. Located in 1507 W Main Street, Gatesville, TX.

Cash / Self-Pay

$3,812

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,877

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: $3,812 (401%)

Insurance Median: $5,877 (619%)

Cash: $3,812 (401% of Medicare)

Ins. Median: $5,877 (619% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 619% of the Medicare baseline (a markup of 519%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Cigna	$424	45%
Blue Cross Blue Shield	$532 - $8,244	56%
Aetna	$587 - $8,759	62%
Coventry	$587 - $8,759	62%
Healthrisk Resource Group	$587 - $8,759	62%
Three Rivers	$587 - $8,759	62%
UnitedHealthcare	$691 - $10,305	73%
Humana	$698 - $10,408	73%
Multiplan	$698 - $10,408	73%
Scott And White	$698 - $10,408	73%
Superior	$698 - $10,408	73%
Triwest	$698 - $10,408	73%
Firstcare	$1,256 - $18,734	132%

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 $3,812.
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 Coryell Memorial 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.