CMS Price Transparency Data

Colonoscopy with biopsy

Facility: St Luke's Patients Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,771
Cash Discount Price: $1,521
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at St Luke's Patients Medical Center is $1,771. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,521. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.45x the Medicare baseline. Located in 4600 East Sam Houston Parkway South, Pasadena, TX.

Cash / Self-Pay

$1,521

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,771

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: $1,521 (124%)

Insurance Median: $1,771 (145%)

Cash: $1,521 (124% of Medicare)

Ins. Median: $1,771 (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
Chc	$408	33%
Tchp	$408	33%
Wellpoint	$429 - $1,771	35%
United	$438 - $3,778	36%
Blue Cross Blue Shield	$753 - $1,928	62%
Aetna	$1,076 - $3,304	88%
Cigna	$1,181 - $7,221	97%
Humana	$1,181 - $1,782	97%
Kelsey	$1,181	97%
Amerivantage	$1,216	99%
Devoted	$1,264	103%
Scanhealth	$1,264	103%
Bright Health	$1,734	142%
Ambetter / Centene	$1,771	145%
Community Health Choice	$1,771	145%
Coventry	$2,826	231%
First Health	$2,826	231%
Healthsmart	$3,043	249%
Multiplan	$3,260	267%
PHCS	$5,185	424%

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 $1,521.
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 St Luke's Patients 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.