CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: PAM Specialty Hospital of San Antonio

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $3,164
Cash Discount Price: $4,083
vs. Medicare Baseline: 3.33x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at PAM Specialty Hospital of San Antonio is $3,164. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,083. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 3.33x the Medicare baseline. Located in 5418 N Loop 1604 W, San Antonio, TX.

Cash / Self-Pay

$4,083

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,164

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: $4,083 (430%)

Insurance Median: $3,164 (333%)

Cash: $4,083 (430% of Medicare)

Ins. Median: $3,164 (333% 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 333% of the Medicare baseline (a markup of 233%). 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
America'S Choice	$2,858	301%
Provider Network Of America	$3,062	322%
Quik Trip	$3,062	322%
Usa Managed Care Organization	$3,062	322%
Velocity Provider Ppo Network	$3,062	322%
Evolutions Healthcare System	$3,266	344%
Multiplan/Phcs	$3,266	344%
Fortified Provider Network	$3,471	365%
Prime Health Services	$3,471	365%
Medincrease	$3,675	387%

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 $4,083.
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 PAM Specialty Hospital of San Antonio 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.