CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Wellspan York Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $612
Cash Discount Price: $4,976
vs. Medicare Baseline: 0.64x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Wellspan York Hospital is $612. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,976. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.64x the Medicare baseline. Located in 1001 South George Street, York, PA.

Cash / Self-Pay

$4,976

Average discount available for prompt cash payment at this facility.

Insurance Median

$612

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: $4,976 (524%)

Insurance Median: $612 (64%)

Cash: $4,976 (524% of Medicare)

Ins. Median: $612 (64% 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
Medicaid / KanCare	$446 - $1,102	47%
Medicare (plans)	$446 - $482	47%
Aetna	$460 - $6,420	48%
Highmark	$670 - $2,751	71%
Johns_Hopkins_Healthcare_Plan	$893	94%
Wellspan_Capital_Blue_Cross	$1,502	158%

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 $4,976.
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 Wellspan York 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.