CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Adventist Health Sonora

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $208
Cash Discount Price: $106
vs. Medicare Baseline: 0.22x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Adventist Health Sonora is $208. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $106. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.22x the Medicare baseline. Located in 1000 Greenley Road, Sonora, CA.

Cash / Self-Pay

$106

Average discount available for prompt cash payment at this facility.

Insurance Median

$208

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: $106 (11%)

Insurance Median: $208 (22%)

Cash: $106 (11% of Medicare)

Ins. Median: $208 (22% 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
Bc Mcal	$50	5%
Celtic Ca Hlth Well Mcal - All Plans	$50	5%
Central Ca Alliance Mcal	$50	5%
Healthnet Mcal	$50	5%
Medi-Cal	$50	5%
Central Ca Alliance Ccs Mcal	$75	8%
Central Ca Alliance Comm Profee Only-All Other Pla	$75	8%
Central Ca Alliance Chdp Mcal	$100	11%
Blue Shield Mcare	$164	17%
Central Ca Alliance Mcr Adv Profee Only	$164	17%
Healthnet Mcr Adv	$164	17%
Tricare	$164	17%
UnitedHealthcare	$164 - $537	17%
Ah Employee Health Plan - All Plans	$181	19%
Cigna	$202	21%
Greatwest Oa/Pos/Hmo	$214	23%
Greatwest Ppo - All Other Plans	$214	23%
Western Growers/Pinnacle - All Plans	$229	24%
Healthnet - All Other Plans	$240	25%
Aetna	$354	37%
Beech Street- All Plans	$561	59%
Trpn - Three Rivers Ppo - All Plans	$561	59%
Blue Shield Epn	$590	62%
Blue Shield - All Other Plans	$623	66%
Bc Mcs	$758	80%
Bc Non-Mcs - All Other Plans	$758	80%

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 $106.
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 Adventist Health Sonora 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.