CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Shriners Hospitals for Children Northern Calif

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $702
Cash Discount Price: $5,334
vs. Medicare Baseline: 0.74x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Shriners Hospitals for Children Northern Calif is $702. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,334. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.74x the Medicare baseline. Located in 2425 Stockton Boulevard, Sacramento, CA.

Cash / Self-Pay

$5,334

Average discount available for prompt cash payment at this facility.

Insurance Median

$702

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: $5,334 (561%)

Insurance Median: $702 (74%)

Cash: $5,334 (561% of Medicare)

Ins. Median: $702 (74% 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
Ambetter / Centene	$166 - $1,388	17%
Amerigroup Nv	$185	19%
Health Plan Of Nv	$205	22%
Aetna	$423 - $1,486	45%
Blue Cross Blue Shield	$423 - $4,100	45%
Central California Alliance For Health	$423	45%
Health Plan Of San Joaquin	$423	45%
Kaiser Permanente	$423 - $1,207	45%
Molina Healthcare Of Ca	$423	45%
Partnership Healthplan Of Ca	$423	45%
Northbay Healthcare	$1,207	127%
Cigna	$1,248	131%
Sutter Medical Foundation	$1,328	140%
Health Net Of Ca	$1,388	146%
UnitedHealthcare	$1,689	178%
Sana Benefits	$1,690	178%
Providence Health Plan	$4,501	474%

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 $5,334.
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 Shriners Hospitals for Children Northern Calif 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.