CMS Price Transparency Data

Colonoscopy with biopsy

Facility: PAM Rehabilitation Hospital of Clear Lake

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $990
Cash Discount Price: $1,320
vs. Medicare Baseline: 0.81x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at PAM Rehabilitation Hospital of Clear Lake is $990. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,320. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.81x the Medicare baseline. Located in 110 East Medical Center Boulevard, Webster, TX.

Cash / Self-Pay

$1,320

Average discount available for prompt cash payment at this facility.

Insurance Median

$990

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: $1,320 (108%)

Insurance Median: $990 (81%)

Cash: $1,320 (108% of Medicare)

Ins. Median: $990 (81% 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
Wellpoint (Amerigroup)	$203	17%
Christus Health Plan	$429	35%
Community Health Choice	$429	35%
Molina Healthcare	$429	35%
Caresource	$451	37%
America'S Choice Provider Network	$924	76%
Provider Network Of America	$990	81%
Quik Trip	$990	81%
Usa Managed Care Organization	$990	81%
Velocity Provider Ppo Network	$990	81%
Multiplan/Phcs	$1,056	86%
Prime Health Services	$1,122	92%
Medincrease	$1,188	97%

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 $1,320.
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 PAM Rehabilitation Hospital of Clear Lake 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.