CMS Price Transparency Data
Colonoscopy with biopsy
Facility: Pennsylvania Hospital
Billing Code: 45380 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45380
- Insurance Median: $2,275
- Cash Discount Price: $4,550
- vs. Medicare Baseline: 1.86x Medicare
The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Pennsylvania Hospital is $2,275. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,550. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.86x the Medicare baseline. Located in 800 Spruce Street, Philadelphia, PA.
Cash / Self-Pay
$4,550
Average discount available for prompt cash payment at this facility.
Insurance Median
$2,275
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: $4,550 (372%)
Insurance Median: $2,275 (186%)
Cash: $4,550 (372% of Medicare)
Ins. Median: $2,275 (186% 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 |
|---|---|---|
| Keystone Mercy Health Plan | $289 | 24% |
| Gateway Health Plan | $320 - $1,552 | 26% |
| Medicaid / KanCare | $320 - $4,550 | 26% |
| Pa Medical Assistance | $320 | 26% |
| Upmc | $383 - $4,550 | 31% |
| UnitedHealthcare | $630 - $4,550 | 52% |
| Horizon Nj Health | $769 - $800 | 63% |
| Health Partners | $939 - $4,550 | 77% |
| Pgm - Regie De L'Assurance Maladie Quebec | $1,046 | 86% |
| Preferred Health Care Eliance | $1,183 | 97% |
| Blue Cross Blue Shield | $1,228 - $20,526 | 100% |
| Medicare (plans) | $1,252 - $1,277 | 102% |
| Philadelphia Va Medical Center | $1,252 | 102% |
| Tricare | $1,258 | 103% |
| Ibc | $1,277 | 104% |
| Cigna | $1,289 - $4,326 | 105% |
| Geisinger Health Plan | $1,289 - $3,969 | 105% |
| Humana | $1,289 - $3,640 | 105% |
| Pa Health And Wellness | $1,314 - $2,065 | 107% |
| Penn Life (Living Independently For Elders) | $1,314 | 107% |
| Aetna | $1,327 - $4,550 | 109% |
| Clover Health Plan | $1,352 | 111% |
| Keystone First | $1,389 | 114% |
| Us Family Health Plan | $1,446 | 118% |
| Ibc Commercial Hpn | $1,533 | 125% |
| Pgm - Kuwait Defense | $1,592 - $2,048 | 130% |
| Devon | $1,729 - $2,048 | 141% |
| Qualcare | $1,729 | 141% |
| Elap | $1,777 | 145% |
| Coventry | $1,820 - $2,320 | 149% |
| Pgm - Chop | $1,820 | 149% |
| Wissahickon Hospice | $1,820 | 149% |
| Claims Watcher | $2,003 - $2,253 | 164% |
| Healthamerica/Coventry | $2,048 - $2,230 | 168% |
| Oscar Health Plan | $2,128 | 174% |
| Olympus | $2,211 | 181% |
| Centivo | $2,253 | 184% |
| First Health Global | $2,275 | 186% |
| Urn-Cancer Resource Services | $2,275 | 186% |
| Elap Services | $2,328 | 190% |
| Keystone Hmo Proactive | $2,617 | 214% |
| Highmark | $2,632 | 215% |
| Health Net | $2,730 | 223% |
| Pgm - Royal Embassy Of Saudi Arabia | $2,730 | 223% |
| Pgm - Embassy Of Qatar | $2,958 | 242% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $2,958 | 242% |
| Pgm - Embassy Of The United Emirates/Ipc | $3,185 | 261% |
| Penn Global Medicine | $3,317 | 271% |
| Devon Health Services Inc | $3,640 | 298% |
| Health America/Ccn | $3,640 | 298% |
| Intergroup | $3,640 | 298% |
| Pgm - Kuwait Health Division | $3,640 | 298% |
| Pgm - Kuwait Oil | $3,640 | 298% |
| Preferred Care | $3,640 | 298% |
| Commercial Other | $4,550 | 372% |
| Community Behavioral Health | $4,550 | 372% |
| International Pfs | $4,550 | 372% |
| Quest Behavioral Health | $4,550 | 372% |
| United Behavioral Health | $4,550 | 372% |
| Workers Compensation | $4,550 | 372% |