CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Scripps Mercy Hospital

Billing Code: 45380 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,535

about 1.3× the $1,223 Medicare rate · typically $1,129–$1,677

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,539

About the fair price

about $4 over the fair price · 1.3× Medicare

Medicare pays $1,223 Fair price $1,535 This hospital $1,539 Cash price $972 Hospital's list price $3,887

How we calculate the fair BaseRate →

How this hospital compares to other CA hospitals

Highest price of the 9 CA hospitals we have prices for — worth calling around.

Cheapest $165 Priciest $1,539

Black dot = this hospital, among the 9 CA hospitals with a price for this procedure. Full list below.

A fair price for a Colonoscopy with biopsy is about $1,535 (about 1.3× the $1,223 Medicare rate). Scripps Mercy Hospital charges insurers about $1,539, or about $972 in cash — about the fair price. Located in San Diego, CA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$184 - $1,616	15%
Blue Cross Blue Shieldmajor	$583 - $1,539	48%
Aetnamajor	$184 - $1,539	15%
Cignamajor	$583 - $1,539	48%
Humanamajor	$1,539	126%
Kaiser Permanentemajor	$1,454 - $1,539	119%
Health Net	$583 - $3,848	48%
HealthPartners	$673 - $1,539	55%
+ 41 smaller / regional plans	$311 - $3,110

Government programs also on file: Medicare, Medicaid.

Excludes 4 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 972), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 45380.

Insurance Before you use insurance

Call your insurance company to confirm Scripps Mercy Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 45380.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

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Other Procedures at Scripps Mercy Hospital

Compare: Colonoscopy with biopsy at other CA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.