CMS Price Transparency Data

Colonoscopy with biopsy

Facility: John Muir Medical Center - Walnut Creek Campus

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,710
Cash Discount Price: $13,638
vs. Medicare Baseline: 2.22x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at John Muir Medical Center - Walnut Creek Campus is $2,710. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $13,638. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 2.22x the Medicare baseline. Located in 1601 Ygnacio Valley Rd, Walnut Creek, CA.

Cash / Self-Pay

$13,638

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,710

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: $13,638 (1116%)

Insurance Median: $2,710 (222%)

Cash: $13,638 (1116% of Medicare)

Ins. Median: $2,710 (222% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 222% of the Medicare baseline (a markup of 122%). 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
Jmpn Canopy Hn [1640000011]	$267	22%
UnitedHealthcare	$267 - $21,354	22%
Contra Costa County Jail [1012104]	$330	27%
Golden State-Network Mcare [1023127]	$1,521 - $2,439	124%
Tricare	$1,602 - $2,577	131%
Health Net-Network Mcare [1028127]	$1,656 - $2,655	135%
Aetna	$1,690 - $12,599	138%
Alignment Health [1177113]	$1,690 - $2,710	138%
Blue Cross Blue Shield	$1,690 - $11,715	138%
Blue Shield-Network Mcare [1006127]	$1,690 - $2,710	138%
Care 1St Health Plan [1094113]	$1,690 - $2,710	138%
Caremore [1171113]	$1,690 - $2,710	138%
Covid19 Hrsa Uninsured Testing And Treatment Fund [1179012]	$1,690 - $2,710	138%
Easy Choice Health Plan [1083113]	$1,690 - $2,710	138%
Essence Healthcare [1049028]	$1,690 - $2,710	138%
Essence Healthcare [1049128]	$1,690 - $2,710	138%
Hospice Of East Bay [1085104]	$1,690 - $2,710	138%
Humana	$1,690 - $3,711	138%
Medicare (plans)	$1,690 - $3,577	138%
Scan-Network Mcare [1043127]	$1,690 - $2,710	138%
Veterans Administration [1051113]	$1,690 - $2,710	138%
Carecentrix [1011001]	$1,788	146%
Generic Commercial/Indemnity [1017001]	$1,788 - $3,387	146%
Workers' Comp [1024005]	$1,858 - $2,912	152%
Aps Healthcare [1003103]	$2,012	165%
Generic Hmo [1018103]	$2,112 - $3,387	173%
Generic Ppo [1021104]	$2,112 - $3,387	173%
United Behavioral Health [1048103]	$2,248 - $21,354	184%
Carelon Behavioral Health [1050104]	$2,459	201%
Fortified Provider Network [1063104]	$2,459	201%
Medigap [1036001]	$2,459	201%
Three Rivers Provider Network [1073104]	$2,459	201%
Health Net Hmo [1028103]	$2,551	209%
Health Net-Network [1028026]	$2,551	209%
Contra Costa Health Plan Hmo [1013103]	$2,683	219%
Blue Shield Hmo [1006103]	$2,772 - $11,574	227%
Blue Shield-Network [1006026]	$2,772 - $11,574	227%
Canopy Hn Hmo [1166103]	$3,092 - $4,959	253%
Health Net Ppo [1028104]	$3,247	266%
Western Health Advantage Hmo [1053103]	$3,353 - $3,577	274%
Federal Correction Institute [1062104]	$3,577	293%
First Health [1016104]	$3,577 - $3,800	293%
Healthsmart - Pka Interplan [1031104]	$3,577	293%
National Provider Network/Plancare America [1069104]	$3,577	293%
Networks By Design [1084104]	$3,577	293%
Pponext [1072104]	$3,577	293%
Sutter Preferred Health Plan [1044104]	$3,577	293%
Kaiser Hmo [1033103]	$3,622	296%
Health Management Network [1066104]	$3,800	311%
Healthcomp [1089104]	$3,800 - $11,715	311%
Donor Network West [1008103]	$4,000	327%
Galaxy Health Network [1064104]	$4,024	329%
Integrated Health Plan [1075104]	$4,024	329%
Brms [1091104]	$5,911 - $11,715	483%
Delta Health Systems [1032104]	$5,911 - $11,715	483%
Empire Plan [1092104]	$5,911 - $11,715	483%
Blue Shield Ppo [1006104]	$11,729 - $15,143	959%
Cigna	$12,628 - $15,785	1033%

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 $13,638.
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 John Muir Medical Center - Walnut Creek Campus 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.