CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Providence Santa Rosa Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $4,737
Cash Discount Price: $1,613
vs. Medicare Baseline: 4.99x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Providence Santa Rosa Memorial Hospital is $4,737. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,613. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 4.99x the Medicare baseline. Located in 1165 Montgomery Dr, Santa Rosa, CA.

Cash / Self-Pay

$1,613

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,737

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: $1,613 (170%)

Insurance Median: $4,737 (499%)

Cash: $1,613 (170% of Medicare)

Ins. Median: $4,737 (499% 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 499% of the Medicare baseline (a markup of 399%). 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
Healthnet	$1,294 - $6,127	136%
Aetna	$1,320 - $15,202	139%
Blue Shield	$2,995 - $3,650	315%
Blue Cross Blue Shield	$4,042 - $5,803	425%
UnitedHealthcare	$4,737 - $5,357	499%

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 $1,613.
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 Providence Santa Rosa 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.