CMS Price Transparency Data

Colonoscopy with biopsy

Facility: UT Health East Texas Rehabilitation Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,779
Cash Discount Price: $605
vs. Medicare Baseline: 1.46x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at UT Health East Texas Rehabilitation Hospital is $1,779. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $605. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.46x the Medicare baseline. Located in 701 Olympic Plaza Cir, Tyler, TX.

Cash / Self-Pay

$605

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,779

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: $605 (49%)

Insurance Median: $1,779 (146%)

Cash: $605 (49% of Medicare)

Ins. Median: $1,779 (146% 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
Amerigroup Commercial [5055]	$1,512	124%
Black Lung [6055]	$1,512	124%
Cigna	$1,512	124%
Healthcare Highways [2210]	$1,512	124%
Healthscope Benefits [2290]	$1,512	124%
Lucent Health [6000]	$1,512	124%
Parkland Community Health Plan [6015]	$1,512	124%
Web Tpa [2115]	$1,512 - $2,499	124%
Blue Cross Blue Shield	$2,045 - $3,092	167%
Aetna	$2,499	204%
Mailhandlers [1595]	$2,499	204%
Andrews Center Behavioral Health [3950]	$3,025	247%
Healthfirst [2395]	$3,025	247%

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 $605.
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 UT Health East Texas Rehabilitation 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.