CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Baylor Scott & White the Heart Hospital Plano

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,049
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Baylor Scott & White the Heart Hospital Plano is $1,049. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.10x the Medicare baseline. Located in 1100 Allied Drive, Plano, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,049

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%)

Insurance Median: $1,049 (110%)

Ins. Median: $1,049 (110% 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.

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
Superior Health Plan	$328 - $878	35%
Baylor Scott & White Health Plan	$794 - $1,379	84%
Aetna	$836 - $5,303	88%
Humana	$836	88%
Triwest	$836	88%
Corvel	$876	92%
Prime Health Services	$876	92%
American Health Plan	$878	92%
Blue Cross Blue Shield	$878 - $2,582	92%
Healthspring	$878	92%
Procare Advantage	$878	92%
UnitedHealthcare	$961 - $2,960	101%
Ambetter / Centene	$1,730	182%
Healthsmart	$3,417	360%
Cigna	$3,779 - $4,446	398%

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 $X.
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 Baylor Scott & White the Heart Hospital 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.