CMS Price Transparency Data
Colonoscopy (diagnostic)
Facility: Hospital of Univ of Pennsylvania
Billing Code: 45378 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45378
- Insurance Median: $977
- Cash Discount Price: $2,673
- vs. Medicare Baseline: 1.03x Medicare
The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Hospital of Univ of Pennsylvania is $977. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,673. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.03x the Medicare baseline. Located in 3400 Spruce St, Philadelphia, PA.
Cash / Self-Pay
$2,673
Average discount available for prompt cash payment at this facility.
Insurance Median
$977
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: $2,673 (281%)
Insurance Median: $977 (103%)
Cash: $2,673 (281% of Medicare)
Ins. Median: $977 (103% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Horizon Nj Health | $71 - $866 | 7% |
| Preferred Health Care Eliance | $92 - $1,084 | 10% |
| Aetna | $95 - $4,927 | 10% |
| Pgm - Regie De L'Assurance Maladie Quebec | $96 - $1,133 | 10% |
| Health Partners | $108 - $4,927 | 11% |
| Blue Cross Blue Shield | $113 - $20,526 | 12% |
| Cigna | $145 - $4,326 | 15% |
| Pgm - Kuwait Defense | $146 - $2,217 | 15% |
| Qualcare | $159 - $1,872 | 17% |
| Olympus | $164 - $1,936 | 17% |
| Coventry | $167 - $2,513 | 18% |
| Pgm - Chop | $167 - $1,971 | 18% |
| Wissahickon Hospice | $167 - $1,971 | 18% |
| UnitedHealthcare | $169 - $4,927 | 18% |
| Medicaid / KanCare | $180 - $4,927 | 19% |
| Pa Medical Assistance | $180 - $4,927 | 19% |
| Healthamerica/Coventry | $188 - $2,414 | 20% |
| Kaiser Permanente | $190 - $4,927 | 20% |
| First Health Global | $209 - $2,464 | 22% |
| Ibc Commercial Hpn | $227 - $1,533 | 24% |
| Keystone Mercy Health Plan | $231 - $4,927 | 24% |
| Keystone Hmo Proactive | $233 - $2,617 | 25% |
| Health Net | $251 - $2,956 | 26% |
| Pgm - Royal Embassy Of Saudi Arabia | $251 - $2,956 | 26% |
| Paired Kidney Exchange | $255 - $493 | 27% |
| Pgm - Embassy Of Qatar | $272 - $3,203 | 29% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $272 - $3,203 | 29% |
| Interlink | $280 - $3,301 | 29% |
| Pgm - Embassy Of The United Emirates/Ipc | $293 - $3,449 | 31% |
| Upmc | $307 - $4,927 | 32% |
| Health America/Ccn | $334 - $3,942 | 35% |
| Humana | $334 - $3,942 | 35% |
| Intergroup | $334 - $3,942 | 35% |
| Pgm - Kuwait Health Division | $334 - $3,942 | 35% |
| Pgm - Kuwait Oil | $334 - $3,942 | 35% |
| Preferred Care | $334 - $3,942 | 35% |
| Blue Quality Centers For Transplant (Bqct) | $418 - $4,927 | 44% |
| City Of Philadelphia Behavioral Health | $418 - $4,927 | 44% |
| Commercial Other | $418 - $4,927 | 44% |
| International Pfs | $418 - $4,927 | 44% |
| United Behavioral Health | $418 - $4,927 | 44% |
| Workers Compensation | $418 - $4,927 | 44% |
| Gspp And Wissahickon Hospice | $489 | 51% |
| Medicare (plans) | $977 - $997 | 103% |
| Philadelphia Va Medical Center | $977 | 103% |
| Tricare | $977 | 103% |
| Ibc | $997 | 105% |
| Geisinger Health Plan | $1,007 - $3,100 | 106% |
| Devoted Health | $1,026 | 108% |
| Pa Health And Wellness | $1,026 - $1,613 | 108% |
| Penn Life (Living Independently For Elders) | $1,026 | 108% |
| Clover Health Plan | $1,056 | 111% |
| Keystone First | $1,085 | 114% |
| Us Family Health Plan | $1,124 | 118% |
| Gateway Health Plan | $1,212 | 128% |
| Elap | $1,388 | 146% |
| Claims Watcher | $1,564 - $1,759 | 165% |
| Oscar Health Plan | $1,662 | 175% |
| Centivo | $1,759 | 185% |
| Elap Services | $1,818 | 191% |
| Highmark | $2,056 | 216% |
| Penn Global Medicine | $2,590 | 273% |