CMS Price Transparency Data
Colonoscopy (diagnostic)
Facility: Pennsylvania Hospital
Billing Code: 45378 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45378
- Insurance Median: $992
- Cash Discount Price: $2,380
- vs. Medicare Baseline: 1.04x Medicare
The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Pennsylvania Hospital is $992. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,380. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.04x the Medicare baseline. Located in 800 Spruce Street, Philadelphia, PA.
Cash / Self-Pay
$2,380
Average discount available for prompt cash payment at this facility.
Insurance Median
$992
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: $2,380 (250%)
Insurance Median: $992 (104%)
Cash: $2,380 (250% of Medicare)
Ins. Median: $992 (104% 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 - $763 | 7% |
| UnitedHealthcare | $86 - $4,342 | 9% |
| Pgm - Regie De L'Assurance Maladie Quebec | $96 - $999 | 10% |
| Health Partners | $108 - $4,342 | 11% |
| Preferred Health Care Eliance | $109 - $1,129 | 11% |
| Blue Cross Blue Shield | $113 - $20,526 | 12% |
| Aetna | $116 - $4,342 | 12% |
| Cigna | $142 - $4,326 | 15% |
| Pgm - Kuwait Defense | $146 - $1,954 | 15% |
| Devon | $159 - $1,954 | 17% |
| Qualcare | $159 - $1,650 | 17% |
| Coventry | $167 - $2,214 | 18% |
| Pgm - Chop | $167 - $1,737 | 18% |
| Wissahickon Hospice | $167 - $1,737 | 18% |
| Ibc Commercial Hpn | $168 - $1,533 | 18% |
| Keystone Hmo Proactive | $172 - $2,617 | 18% |
| Gateway Health Plan | $180 - $1,206 | 19% |
| Medicaid / KanCare | $180 - $4,342 | 19% |
| Pa Medical Assistance | $180 - $443 | 19% |
| Healthamerica/Coventry | $188 - $2,128 | 20% |
| Olympus | $203 - $2,110 | 21% |
| First Health Global | $209 - $2,171 | 22% |
| Urn-Cancer Resource Services | $209 - $2,171 | 22% |
| Keystone Mercy Health Plan | $231 | 24% |
| Health Net | $251 - $2,605 | 26% |
| Pgm - Royal Embassy Of Saudi Arabia | $251 - $2,605 | 26% |
| Pgm - Embassy Of Qatar | $272 - $2,822 | 29% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $272 - $2,822 | 29% |
| Pgm - Embassy Of The United Emirates/Ipc | $293 - $3,039 | 31% |
| Upmc | $307 - $4,342 | 32% |
| Devon Health Services Inc | $334 - $3,474 | 35% |
| Health America/Ccn | $334 - $3,474 | 35% |
| Humana | $334 - $3,474 | 35% |
| Intergroup | $334 - $3,474 | 35% |
| Pgm - Kuwait Health Division | $334 - $3,474 | 35% |
| Pgm - Kuwait Oil | $334 - $3,474 | 35% |
| Preferred Care | $334 - $3,474 | 35% |
| Commercial Other | $418 - $4,342 | 44% |
| Community Behavioral Health | $418 - $4,342 | 44% |
| International Pfs | $418 - $4,342 | 44% |
| Quest Behavioral Health | $418 - $4,342 | 44% |
| United Behavioral Health | $418 - $4,342 | 44% |
| Workers Compensation | $418 - $4,342 | 44% |
| Medicare (plans) | $973 - $992 | 102% |
| Philadelphia Va Medical Center | $973 | 102% |
| Tricare | $977 | 103% |
| Ibc | $992 | 104% |
| Geisinger Health Plan | $1,002 - $3,085 | 105% |
| Pa Health And Wellness | $1,021 - $1,605 | 107% |
| Penn Life (Living Independently For Elders) | $1,021 | 107% |
| Clover Health Plan | $1,050 | 111% |
| Keystone First | $1,080 | 114% |
| Us Family Health Plan | $1,124 | 118% |
| Elap | $1,381 | 145% |
| Claims Watcher | $1,556 - $1,751 | 164% |
| Oscar Health Plan | $1,654 | 174% |
| Centivo | $1,751 | 184% |
| Elap Services | $1,809 | 190% |
| Highmark | $2,045 | 215% |
| Penn Global Medicine | $2,578 | 271% |