CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Seneca District Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $3,057
Cash Discount Price: $2,574
vs. Medicare Baseline: 2.50x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Seneca District Hospital is $3,057. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,574. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 2.50x the Medicare baseline. Located in 130 Brentwood Drive, Chester, CA.

Cash / Self-Pay

$2,574

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,057

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$1,222.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $1,222.56 (100%)

Cash / Self-Pay: $2,574 (211%)

Insurance Median: $3,057 (250%)

Cash: $2,574 (211% of Medicare)

Ins. Median: $3,057 (250% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $1,222.56 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 250% of the Medicare baseline (a markup of 150%). 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	$330	27%
Amthem Bc Mcal	$335	27%
Ambetter / Centene	$403	33%
Partnership Hp-All Plans	$1,156	95%
UnitedHealthcare	$1,223 - $3,154	100%
Tricare	$2,253	184%
Imperial Hp Ma-All Plans	$2,545	208%
Blue Cross Blue Shield	$2,636 - $2,896	216%
Blue Shield Ipf/Ca Exchange	$2,867	235%
Beech Street Corp- All Plans	$3,057	250%
Cigna	$3,057	250%
Integrated Hp-All Plans	$3,057	250%
Interplan Corp- All Plans	$3,057	250%
Medincrease- All Plans	$3,057	250%
Multiplan- All Plans	$3,057	250%
Pacificare - All Plans	$3,057	250%
Provider Ntwrk Of America-All Plans	$3,057	250%
Alliance- All Plans	$3,121	255%
Community Care Network - All Plans	$3,121	255%
Coventry- All Plans	$3,154	258%
Northern Nevada Health Network- All Plans	$3,154	258%
Superior California Ppo - All Plans	$3,154	258%
Blue Shield Of Ca- All Other Plans	$3,186	261%
Healthnet - All Other Plans	$3,186	261%
Three Rivers- All Plans	$3,186	261%

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 $2,574.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45380.

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 45380.
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.