CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Grossmont Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,345
Cash Discount Price: $2,756
vs. Medicare Baseline: 1.92x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Grossmont Hospital is $2,345. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,756. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.92x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$2,756

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,345

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: $2,756 (225%)

Insurance Median: $2,345 (192%)

Cash: $2,756 (225% of Medicare)

Ins. Median: $2,345 (192% 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
Aetna	$375 - $2,536	31%
Molina	$375 - $2,756	31%
Health Net	$514 - $2,940	42%
Cigna	$1,029 - $2,756	84%
Blue Cross Blue Shield	$1,250 - $2,940	102%
Medi-Cal	$1,250	102%
Blue Shield	$1,838 - $2,572	150%
Interplan	$1,838 - $15,436	150%
Community Health Group	$2,047	167%
Epic Americas	$2,205 - $2,572	180%
County Medical Services	$2,345	192%
Medicare (plans)	$2,536	207%
UnitedHealthcare	$2,572 - $3,308	210%
San Diego Pace	$2,756	225%
Allianz Global Assistance	$2,940	240%
Managed Health Network	$2,940	240%

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 $2,756.
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 Grossmont Hospital 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.