CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Jefferson Abington Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $405
Cash Discount Price: $962
vs. Medicare Baseline: 0.33x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Jefferson Abington Hospital is $405. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $962. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.33x the Medicare baseline. Located in 1200 Old York Road, Abington, PA.

Cash / Self-Pay

$962

Average discount available for prompt cash payment at this facility.

Insurance Median

$405

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: $962 (79%)

Insurance Median: $405 (33%)

Cash: $962 (79% of Medicare)

Ins. Median: $405 (33% 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
Abington Pro Ibc	$211 - $263	17%
Medicare (plans)	$223 - $297	18%
Medicaid / KanCare	$248 - $449	20%
Keystone First	$277 - $394	23%
Jup Pa Health_Wellness	$293	24%
Pa Health_Wellness Chc	$293 - $416	24%
Jup Health Partners Chip	$322 - $407	26%
Aetna	$337 - $3,077	28%
Jup Highmark	$375	31%
Jup Geisinger Commercial	$401 - $529	33%
Ibc	$1,729 - $3,508	141%
Cigna	$2,375 - $2,850	194%
UnitedHealthcare	$2,493	204%
Blue Cross Blue Shield	$2,704	221%
Upmc Commercial	$2,850	233%

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 $962.
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 Jefferson Abington Hospital 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.