CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Penn State Health St. Joseph

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,078
Cash Discount Price: $1,541
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Penn State Health St. Joseph is $1,078. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,541. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.13x the Medicare baseline. Located in 2500 Bernville Road, Reading, PA.

Cash / Self-Pay

$1,541

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,078

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: $1,541 (162%)

Insurance Median: $1,078 (113%)

Cash: $1,541 (162% of Medicare)

Ins. Median: $1,078 (113% 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
[Amerihealth Caritas]	$804 - $946	85%
[Highmark Wholecare]	$804 - $946	85%
[Geisinger]	$851 - $4,275	90%
[Health Partners Plans]	$880 - $965	93%
[Pa Health & Wellness]	$884 - $974	93%
[Highmark]	$936 - $5,141	99%
UnitedHealthcare	$946 - $4,012	100%
[Cbc]	$946 - $3,132	100%
[Ibc]	$946 - $2,945	100%
Aetna	$955 - $3,027	101%
Humana	$955	101%
[Healthspring]	$955	101%
[Upmc]	$965 - $4,378	102%
[Point Comfort Underwriters]	$1,182	124%
Cigna	$3,636	383%
[Highmark Choice Blue]	$4,112	433%
[Highmark Aca]	$4,318	454%
[Preferred Healthcare Systems]	$4,444	468%
[First Health]	$4,741	499%
[Multiplan]	$4,741	499%

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 $1,541.
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 Penn State Health St. Joseph 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.