CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Sarasota Memorial Hospital - Venice

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,695
Cash Discount Price: $1,923
vs. Medicare Baseline: 1.78x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Sarasota Memorial Hospital - Venice is $1,695. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,923. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.78x the Medicare baseline. Located in 2600 Laurel Road East, North Venice, FL.

Cash / Self-Pay

$1,923

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,695

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: $1,923 (202%)

Insurance Median: $1,695 (178%)

Cash: $1,923 (202% of Medicare)

Ins. Median: $1,695 (178% 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
Simply Healthcare	$637 - $669	67%
Sunshine State	$669	70%
Molina	$688	72%
Amerihealth Caritas	$701	74%
Community Care Plan	$701	74%
Florida Community Care	$701 - $1,007	74%
Blue Cross Blue Shield	$915	96%
Aetna	$943 - $4,729	99%
UnitedHealthcare	$943 - $4,474	99%
Simply Freedom Optimum	$961	101%
Wellcare	$961	101%
Careworks	$1,358 - $2,164	143%
Enlyte	$1,358 - $2,164	143%
Oscar Health	$2,032	214%
Ambetter / Centene	$2,471	260%
Avmed	$3,510	369%
Usa Managed Care	$3,846	405%
First Health	$3,991	420%

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 $1,923.
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 Sarasota Memorial Hospital - Venice 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.