CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Loma Linda University Children's Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,206
Cash Discount Price: $2,115
vs. Medicare Baseline: 2.32x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Loma Linda University Children's Hospital is $2,206. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,115. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.32x the Medicare baseline. Located in 11234 Anderson Street Suite A, Loma Linda, CA.

Cash / Self-Pay

$2,115

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,206

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: $2,115 (223%)

Insurance Median: $2,206 (232%)

Cash: $2,115 (223% of Medicare)

Ins. Median: $2,206 (232% 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 232% of the Medicare baseline (a markup of 132%). 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
Inland Empire Health Plan (Iehp)	$496 - $1,158	52%
Kaiser Foundation Hospitals	$561 - $3,679	59%
Adventist Health	$776 - $1,103	82%
Lluh Dept Of Risk Management	$932 - $1,324	98%
Alpha Care Medical Group	$1,158 - $1,738	122%
Dignity Health	$1,158 - $1,738	122%
Epic Health Plan	$1,158 - $2,206	122%
Upland Medical Group	$1,158	122%
Vantage Medical Group	$1,158 - $1,738	122%
Trivalley Medical Group	$1,390	146%
Molina Healthcare Of Ca	$1,460 - $1,552	154%
Heritage Provider Network	$1,900	200%
Global Benefits Group	$2,329 - $3,310	245%
Temecula Valley Physicians Medical Group	$2,329	245%
Blue Shield Of California	$2,470 - $11,231	260%
Cigna	$2,484 - $2,873	261%
Networks By Design	$2,523 - $3,585	266%
Multiplan	$3,106 - $4,413	327%
Galaxy Health	$3,300 - $4,689	347%
Prime Health Services	$3,300 - $4,689	347%
UnitedHealthcare	$4,122 - $7,378	434%
Blue Cross Blue Shield	$5,398	568%
Aetna	$7,385	777%

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 $2,115.
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 Loma Linda University Children's 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.