CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Grossmont Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,911
Cash Discount Price: $2,537
vs. Medicare Baseline: 2.01x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Grossmont Hospital is $1,911. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,537. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.01x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$2,537

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,911

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: $2,537 (267%)

Insurance Median: $1,911 (201%)

Cash: $2,537 (267% of Medicare)

Ins. Median: $1,911 (201% 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 201% of the Medicare baseline (a markup of 101%). 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
Health Net	$214 - $3,045	23%
Blue Cross Blue Shield	$474 - $3,315	50%
Community Health Group	$507 - $2,537	53%
Managed Health Network	$507 - $2,284	53%
Blue Shield	$592 - $2,368	62%
California Health And Wellness	$592 - $2,706	62%
UnitedHealthcare	$592 - $3,315	62%
Aetna	$947 - $3,315	100%
County Medical Services	$1,005 - $2,774	106%
Epic Americas	$1,005 - $2,368	106%
Humana	$1,005 - $2,158	106%
Interplan	$1,150 - $2,284	121%
Molina	$1,150 - $2,368	121%
Multiplan	$1,150 - $2,368	121%
San Diego Pace	$1,150 - $1,911	121%
Indian Health Council	$1,566	165%
Cigna	$1,692 - $2,774	178%
Medicare (plans)	$1,692 - $2,706	178%
Kaiser	$1,861	196%
Allianz Global Assistance	$2,064	217%
Medi-Cal	$2,148 - $2,537	226%

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 $2,537.
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 Grossmont Hospital 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.