CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Santa Monica - UCLA Med Ctr & Orthopaedic Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,274
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Santa Monica - UCLA Med Ctr & Orthopaedic Hospital is $1,274. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.34x the Medicare baseline. Located in 1250 16Th Street, Santa Monica, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,274

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%)

Insurance Median: $1,274 (134%)

Ins. Median: $1,274 (134% 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.

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
Blue Shield	$1,158 - $6,999	122%
La Care Dsnp	$1,158	122%
Monarch	$1,158	122%
UnitedHealthcare	$1,158 - $3,433	122%
Aetna	$1,196	126%
Medicare (plans)	$1,196 - $1,274	126%
St. Jude	$1,196	126%
Triwest Healthcare Alliance	$1,196	126%
Blue Cross Blue Shield	$1,262 - $5,326	133%
Providence Healthcare	$1,274	134%
Central Health Plan	$1,370	144%
Healthsmart	$1,435	151%
Scan	$1,564	165%
La Care Covered Ca	$1,599	168%
Centivo	$2,871	302%
Health Plan Of Nevada Commercial	$3,332	351%

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 $X.
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 Santa Monica - UCLA Med Ctr & Orthopaedic 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.