CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Seneca District Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,822
Cash Discount Price: $2,376
vs. Medicare Baseline: 2.97x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Seneca District Hospital is $2,822. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,376. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.97x the Medicare baseline. Located in 130 Brentwood Drive, Chester, CA.

Cash / Self-Pay

$2,376

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,822

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: $2,376 (250%)

Insurance Median: $2,822 (297%)

Cash: $2,376 (250% of Medicare)

Ins. Median: $2,822 (297% 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 297% of the Medicare baseline (a markup of 197%). 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
Medi-Cal	$295	31%
Amthem Bc Mcal	$300	32%
Ambetter / Centene	$360	38%
Partnership Hp-All Plans	$1,033	109%
UnitedHealthcare	$1,129 - $2,911	119%
Tricare	$2,079	219%
Imperial Hp Ma-All Plans	$2,349	247%
Blue Cross Blue Shield	$2,432 - $2,673	256%
Blue Shield Ipf/Ca Exchange	$2,646	278%
Beech Street Corp- All Plans	$2,822	297%
Cigna	$2,822	297%
Integrated Hp-All Plans	$2,822	297%
Interplan Corp- All Plans	$2,822	297%
Medincrease- All Plans	$2,822	297%
Multiplan- All Plans	$2,822	297%
Pacificare - All Plans	$2,822	297%
Provider Ntwrk Of America-All Plans	$2,822	297%
Alliance- All Plans	$2,881	303%
Community Care Network - All Plans	$2,881	303%
Coventry- All Plans	$2,911	306%
Northern Nevada Health Network- All Plans	$2,911	306%
Superior California Ppo - All Plans	$2,911	306%
Blue Shield Of Ca- All Other Plans	$2,940	309%
Healthnet - All Other Plans	$2,940	309%
Three Rivers- All Plans	$2,940	309%

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 $2,376.
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 Seneca District 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.