CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Sharp Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,300
Cash Discount Price: $2,537
vs. Medicare Baseline: 2.42x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Sharp Memorial Hospital is $2,300. 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 2.42x the Medicare baseline. Located in 7901 Frost St, San Diego, CA.

Cash / Self-Pay

$2,537

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,300

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: $2,300 (242%)

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

Ins. Median: $2,300 (242% 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 242% of the Medicare baseline (a markup of 142%). 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
Aetna	$507 - $2,706	53%
Medicare (plans)	$725 - $2,537	76%
Indian Health Council	$947	100%
Health Net	$1,421 - $2,368	150%
Interplan	$1,421 - $1,692	150%
UnitedHealthcare	$1,421 - $2,368	150%
San Diego Pace	$1,692	178%
Community Health Group	$1,861 - $3,045	196%
Kaiser	$1,911	201%
Blue Shield	$2,064 - $2,300	217%
Humana	$2,064 - $2,706	217%
Epic Americas	$2,131	224%
Blue Cross Blue Shield	$2,267 - $2,605	239%
County Medical Services	$2,368	249%
Managed Health Network	$2,368	249%
Multiplan	$2,368	249%
Allianz Global Assistance	$2,537	267%
Cigna	$2,537 - $3,315	267%

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 Sharp Memorial 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.