CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Watsonville Community Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $474
Cash Discount Price: $2,393
vs. Medicare Baseline: 0.39x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Watsonville Community Hospital is $474. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,393. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.39x the Medicare baseline. Located in 75 Nielson Street, Watsonville, CA.

Cash / Self-Pay

$2,393

Average discount available for prompt cash payment at this facility.

Insurance Median

$474

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: $2,393 (196%)

Insurance Median: $474 (39%)

Cash: $2,393 (196% of Medicare)

Ins. Median: $474 (39% 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.

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
Medicaid / KanCare	$416 - $474	34%
Ccs/Monterey County	$416 - $474	34%
Medi-Cal E.R.	$416 - $474	34%
Healthy Families	$416 - $474	34%
California Childrens Srvs	$416 - $474	34%
Well Path	$416 - $474	34%
Medi-Cal/Eds	$416 - $474	34%
Alliance/Sccho	$611 - $812	50%
City of Wats/Pinnacle Clm	$4,549	372%
Delta Health Systems	$4,549	372%
Sheet Metal Workers	$4,549	372%
State Compensation Fund	$4,549	372%
Teamsters Benefit Trust	$4,549	372%
Laborers Health & Welfare	$4,549	372%
Pinnacle Claims Tpa/Bc	$4,549	372%
Robert Kennedy/Ccn	$4,549	372%
Western Growers Trust/Bc	$4,549	372%
Blue Cross Blue Shield	$4,549	372%
Calif Ironworkers Field	$4,549	372%
Operating Engineers	$4,549	372%
Carpenters H&W Trust	$4,549	372%
Monterey Bay Pub Emp Trst	$4,549	372%
Claims Management Wc	$4,549	372%
Aetna	$4,963	406%

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 $2,393.
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 Watsonville Community 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.