CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Penn State Health St. Joseph

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,387
Cash Discount Price: $1,993
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Penn State Health St. Joseph is $1,387. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,993. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.13x the Medicare baseline. Located in 2500 Bernville Road, Reading, PA.

Cash / Self-Pay

$1,993

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,387

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: $1,993 (163%)

Insurance Median: $1,387 (113%)

Cash: $1,993 (163% of Medicare)

Ins. Median: $1,387 (113% 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
[Amerihealth Caritas]	$1,034 - $1,217	85%
[Highmark Wholecare]	$1,034 - $1,217	85%
[Geisinger]	$1,095 - $5,529	90%
[Health Partners Plans]	$1,132 - $1,241	93%
[Pa Health & Wellness]	$1,138 - $1,254	93%
[Highmark]	$1,205 - $6,615	99%
UnitedHealthcare	$1,217 - $5,189	100%
[Cbc]	$1,217 - $4,051	100%
[Ibc]	$1,217 - $3,809	100%
Aetna	$1,229 - $3,914	101%
Humana	$1,229	101%
[Healthspring]	$1,229	101%
[Upmc]	$1,241 - $5,662	102%
[Point Comfort Underwriters]	$1,521	124%
Cigna	$4,702	385%
[Highmark Choice Blue]	$5,292	433%
[Highmark Aca]	$5,556	454%
[Preferred Healthcare Systems]	$5,748	470%
[First Health]	$6,131	501%
[Multiplan]	$6,131	501%

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 $1,993.
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 Penn State Health St. Joseph 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.