Colonoscopy (diagnostic)
Facility: Alhambra Hospital Medical Center
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $5,786
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 6.09x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 609% of the Medicare baseline (a markup of 509%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Citrus Valley Health Partners | $295 | 31% |
| La Care Pasc Seiu Misc | $295 | 31% |
| La Care Medi-Cal Hmo | $340 | 36% |
| Central Health Plan Of Ca Senior Hmo | $421 | 44% |
| Allied Physicians Of Ca Medi-Cal | $423 | 45% |
| Health Net Medi-Cal | $423 | 45% |
| Kaiser Medi-Cal | $423 | 45% |
| Medi-Cal | $423 | 45% |
| Miscellaneous Medi-Cal Hmo | $423 | 45% |
| Blue Cross Blue Shield | $491 - $5,978 | 52% |
| Aetna | $621 - $5,900 | 65% |
| Molina Health Plan | $684 | 72% |
| Stewart Mg Senior Hmo | $800 | 84% |
| Ahmc-Reciprocity-Comm/Senior | $1,196 | 126% |
| Ahmc-Reciprocity-Medi-Cal/Healthy Families | $1,196 | 126% |
| Miscellaneous Work Comp Hmo | $1,591 | 167% |
| Blue Shield Value Network Exchange | $1,820 | 192% |
| Blue Shield Hmo/Ppo | $2,029 | 214% |
| UnitedHealthcare | $3,396 - $5,900 | 357% |
| Tricare | $4,875 | 513% |
| Blue Shield 65 Plus | $5,555 | 585% |
| Apa Aco | $5,700 | 600% |
| Altamed Senior Services | $5,786 | 609% |
| Brand New Day Sr | $5,786 | 609% |
| Health Net Senior Hmo | $5,786 | 609% |
| Medicare (plans) | $5,786 - $6,194 | 609% |
| Alignment Senior Hmo | $5,900 | 621% |
| Allied Physicians Comm/Sr | $5,900 | 621% |
| Humana | $5,900 | 621% |
| La Care Exchange | $5,900 | 621% |
| Miscellaneous Senior Hmo | $5,900 | 621% |
| Wellcare Senior Hmo | $5,900 | 621% |
| Health Net Salud Con Hmo | $7,174 | 755% |
| Molina Exchange | $7,233 | 761% |
| Health Net Exchange | $7,274 | 766% |
| Ahmc Health | $8,679 | 913% |
| Allied Physicians Of Ca Commercial | $8,849 | 931% |
| Health Net Ppo/Epo/Pos | $12,300 | 1295% |