CMS Price Transparency Data

Colonoscopy with biopsy

Facility: PAM Specialty Hospital of San Antonio Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,773
Cash Discount Price: $2,364
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at PAM Specialty Hospital of San Antonio Medical Center is $1,773. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,364. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.45x the Medicare baseline. Located in 8902 Floyd Curl Dr, San Antonio, TX.

Cash / Self-Pay

$2,364

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,773

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: $2,364 (193%)

Insurance Median: $1,773 (145%)

Cash: $2,364 (193% of Medicare)

Ins. Median: $1,773 (145% 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
Aetna	$192	16%
America'S Choice	$1,655	135%
Provider Network Of America	$1,773	145%
Quik Trip	$1,773	145%
Usa Mco	$1,773	145%
Velocity Provider Ppo Network	$1,773	145%
Evolutions Healthcare System	$1,891	155%
Multiplan/Phcs	$1,891	155%
Fortified Provider Network	$2,010	164%
Prime Health Services	$2,010	164%
Medincrease	$2,128	174%

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 $2,364.
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 PAM Specialty Hospital of San Antonio Medical Center 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.