CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Milton S Hershey Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,380
Cash Discount Price: $2,539
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Milton S Hershey Medical Center is $1,380. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,539. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.13x the Medicare baseline. Located in 500 University Drive, Hershey, PA.

Cash / Self-Pay

$2,539

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,380

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: $2,539 (208%)

Insurance Median: $1,380 (113%)

Cash: $2,539 (208% of Medicare)

Ins. Median: $1,380 (113% 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
[Amerihealth Caritas]	$1,079 - $1,269	88%
[Highmark Wholecare]	$1,079 - $1,269	88%
[Geisinger]	$1,142 - $5,711	93%
[Health Partners Plans]	$1,180 - $1,295	97%
[Pa Health & Wellness]	$1,187 - $1,307	97%
[Highmark]	$1,256 - $6,825	103%
Aetna	$1,282 - $5,191	105%
Humana	$1,282	105%
[Healthspring]	$1,282	105%
UnitedHealthcare	$1,295 - $5,526	106%
[Upmc]	$1,295 - $5,662	106%
[Cbc]	$1,380 - $5,076	113%
[Point Comfort Underwriters]	$1,586	130%
[Highmark Aca]	$4,778	391%
Cigna	$4,900	401%
[Highmark Choice Blue]	$5,460	447%
[Preferred Healthcare Systems]	$5,748	470%
[First Health]	$6,131	501%
[Multiplan]	$6,131	501%

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 $2,539.
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 Milton S Hershey Medical Center 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.