CMS Price Transparency Data
Colonoscopy with biopsy
Facility: Hospital of Univ of Pennsylvania
Billing Code: 45380 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45380
- Insurance Median: $2,200
- Cash Discount Price: $4,399
- vs. Medicare Baseline: 1.80x Medicare
The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Hospital of Univ of Pennsylvania is $2,200. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,399. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.80x the Medicare baseline. Located in 3400 Spruce St, Philadelphia, PA.
Cash / Self-Pay
$4,399
Average discount available for prompt cash payment at this facility.
Insurance Median
$2,200
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: $4,399 (360%)
Insurance Median: $2,200 (180%)
Cash: $4,399 (360% of Medicare)
Ins. Median: $2,200 (180% 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
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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 |
|---|---|---|
| Medicaid / KanCare | $320 - $4,399 | 26% |
| Pa Medical Assistance | $320 - $4,399 | 26% |
| Kaiser Permanente | $336 - $4,399 | 27% |
| Upmc | $383 - $4,399 | 31% |
| Keystone Mercy Health Plan | $410 - $4,399 | 34% |
| Paired Kidney Exchange | $440 | 36% |
| Gspp And Wissahickon Hospice | $629 | 51% |
| UnitedHealthcare | $630 - $4,399 | 52% |
| Horizon Nj Health | $743 - $773 | 61% |
| Health Partners | $943 - $4,399 | 77% |
| Preferred Health Care Eliance | $968 | 79% |
| Pgm - Regie De L'Assurance Maladie Quebec | $1,012 | 83% |
| Blue Cross Blue Shield | $1,188 - $20,526 | 97% |
| Medicare (plans) | $1,258 - $1,283 | 103% |
| Philadelphia Va Medical Center | $1,258 | 103% |
| Tricare | $1,258 | 103% |
| Ibc | $1,283 | 105% |
| Cigna | $1,296 - $4,326 | 106% |
| Geisinger Health Plan | $1,296 - $3,989 | 106% |
| Humana | $1,296 - $3,519 | 106% |
| Devoted Health | $1,321 | 108% |
| Pa Health And Wellness | $1,321 - $2,075 | 108% |
| Penn Life (Living Independently For Elders) | $1,321 | 108% |
| Aetna | $1,333 - $4,399 | 109% |
| Clover Health Plan | $1,358 | 111% |
| Keystone First | $1,396 | 114% |
| Us Family Health Plan | $1,446 | 118% |
| Ibc Commercial Hpn | $1,533 | 125% |
| Pgm - Kuwait Defense | $1,540 - $1,980 | 126% |
| Gateway Health Plan | $1,560 | 128% |
| Qualcare | $1,672 | 137% |
| Olympus | $1,729 | 141% |
| Coventry | $1,760 - $2,243 | 144% |
| Pgm - Chop | $1,760 | 144% |
| Wissahickon Hospice | $1,760 | 144% |
| Elap | $1,786 | 146% |
| Healthamerica/Coventry | $1,980 - $2,156 | 162% |
| Claims Watcher | $2,012 - $2,264 | 165% |
| Oscar Health Plan | $2,138 | 175% |
| First Health Global | $2,200 | 180% |
| Centivo | $2,264 | 185% |
| Elap Services | $2,339 | 191% |
| Keystone Hmo Proactive | $2,617 | 214% |
| Health Net | $2,639 | 216% |
| Pgm - Royal Embassy Of Saudi Arabia | $2,639 | 216% |
| Highmark | $2,645 | 216% |
| Pgm - Embassy Of Qatar | $2,859 | 234% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $2,859 | 234% |
| Interlink | $2,947 | 241% |
| Pgm - Embassy Of The United Emirates/Ipc | $3,079 | 252% |
| Penn Global Medicine | $3,333 | 273% |
| Health America/Ccn | $3,519 | 288% |
| Intergroup | $3,519 | 288% |
| Pgm - Kuwait Health Division | $3,519 | 288% |
| Pgm - Kuwait Oil | $3,519 | 288% |
| Preferred Care | $3,519 | 288% |
| Blue Quality Centers For Transplant (Bqct) | $4,399 | 360% |
| City Of Philadelphia Behavioral Health | $4,399 | 360% |
| Commercial Other | $4,399 | 360% |
| International Pfs | $4,399 | 360% |
| United Behavioral Health | $4,399 | 360% |
| Workers Compensation | $4,399 | 360% |