CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Seton Medical Center Harker Heights

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,020
Cash Discount Price: $261
vs. Medicare Baseline: 0.83x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Seton Medical Center Harker Heights is $1,020. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $261. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.83x the Medicare baseline. Located in 850 W Central Texas Expressway, Harker Heights, TX.

Cash / Self-Pay

$261

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,020

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: $261 (21%)

Insurance Median: $1,020 (83%)

Cash: $261 (21% of Medicare)

Ins. Median: $1,020 (83% 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
Medicaid / KanCare	$352 - $1,020	29%
Healthscope Benefits [2290]	$471	39%
UnitedHealthcare	$471 - $1,020	39%
Aetna	$484 - $1,501	40%
Bell County Indigent Health Svc [3530]	$496	41%
Healthcare Highways [2210]	$1,020	83%
Oncology Patient Assistance Programs [2295]	$1,020	83%
Selecthealth [3740]	$1,020	83%
Web Tpa [2115]	$1,020 - $2,092	83%
Blue Cross Blue Shield	$1,935	158%
First Care Commercial [1371]	$1,961	160%
Allied Benefit Systems Inc [1030]	$2,092	171%
Cigna	$2,264	185%

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 $261.
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 Seton Medical Center Harker Heights 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.