CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Mayers Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,903
Cash Discount Price: $2,298
vs. Medicare Baseline: 2.00x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Mayers Memorial Hospital is $1,903. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,298. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.00x the Medicare baseline. Located in 43563 Hwy 299 East, Fall River Mills, CA.

Cash / Self-Pay

$2,298

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,903

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: $2,298 (242%)

Insurance Median: $1,903 (200%)

Cash: $2,298 (242% of Medicare)

Ins. Median: $1,903 (200% 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 200% of the Medicare baseline (a markup of 100%). 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
Blue Shield Ca Va	$156 - $1,808	16%
Blue Shield Mcr Adv	$156 - $1,808	16%
Tricare	$156 - $1,903	16%
Health Net Mcr Adv	$164 - $1,903	17%
Arcadian Health Services-All Plans	$173 - $1,903	18%
Imperial Health Plan-All Plans	$186 - $2,151	20%
Medi-Cal	$295	31%
Partnership Hp-All Plans	$1,181	124%
Cigna	$1,626 - $2,740	171%
Corvel Ppo-All Plans	$1,626 - $2,740	171%
Coventry/First Health-All Plans	$1,626 - $2,740	171%
Integrated Hp-All Plans	$1,626 - $2,740	171%
Interplan-All Plans	$1,626 - $2,740	171%
Blue Cross Blue Shield	$1,922 - $2,466	202%
Health Net Prison	$2,075	218%
Blue Shield Ca Exchange	$2,466	260%
Blue Shield-All Other Plans	$2,740	288%
Hmn-All Plans	$2,740	288%
Multiplan Phcs-All Plans	$2,740	288%
Pfmc-All Plans	$2,740	288%
Superior Ca-All Plans	$2,740	288%
Health Net-All Other Plans	$2,870	302%
Pacificare-All Plans	$2,884	304%

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 $2,298.
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 Mayers 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.