CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Childrens Medical Center Plano

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,499
Cash Discount Price: $2,678
vs. Medicare Baseline: 2.63x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Childrens Medical Center Plano is $2,499. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,678. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.63x the Medicare baseline. Located in 7601 Preston Road, Plano, TX.

Cash / Self-Pay

$2,678

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,499

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: $2,678 (282%)

Insurance Median: $2,499 (263%)

Cash: $2,678 (282% of Medicare)

Ins. Median: $2,499 (263% 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 263% of the Medicare baseline (a markup of 163%). 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
Aetna	$283 - $2,500	30%
Humana	$283 - $2,678	30%
Medicaid / KanCare	$283 - $440	30%
Oklahoma Complete Health	$283 - $440	30%
Superior Health Plan	$345 - $712	36%
Firstcare Health	$814	86%
Parkland Community	$1,178	124%
Cookchildren'S Health Plan	$1,214	128%
Molina Healthcare	$1,250	132%
Carelon	$1,321 - $1,749	139%
Texas Children'S Health Plan	$1,357	143%
Wellpoint	$1,357	143%
Blue Cross Blue Shield	$1,428 - $2,900	150%
UnitedHealthcare	$1,892 - $2,800	199%
Methodist	$2,033 - $2,380	214%
Cigna	$2,356 - $2,600	248%
Employers Health Network	$2,499	263%
Imagine Health	$2,499	263%
Scott & White	$2,535	267%
Txp Emerging Therapy Solutions	$2,535	267%
Healthsmart	$2,606 - $3,034	274%
Healthscope Benefit Solutions	$2,678	282%
Phcs	$2,678	282%
Quiktrip (Qt)	$2,678	282%
Txp Interlink	$2,678	282%
Coventry Health	$2,856	301%
Equifax Healthcare	$3,034	319%
Multiplan	$3,034	319%
Usa Managed Care	$3,320	349%
Galaxy Health	$3,463	364%

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 $2,678.
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 Childrens Medical Center Plano 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.