CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: St Mary Medical Center

Billing Code: 45378 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$157

about 0.2× the $950 Medicare rate · typically $81–$1,055

modeled estimate · not a bill or quote

What this hospital charges insurers

$90

Below the fair price — a good deal

about $67 under the fair price · 0.1× Medicare

Medicare pays $950 Fair price $157 This hospital $90 Hospital's list price $475

How we calculate the fair BaseRate →

How this hospital compares to other PA hospitals

Lowest price of the 9 PA hospitals we have prices for — a strong deal.

Cheapest $90 Priciest $262

Black dot = this hospital, among the 9 PA hospitals with a price for this procedure. Full list below.

A fair price for a Colonoscopy (diagnostic) is about $157 (about 0.2× the $950 Medicare rate). St Mary Medical Center charges insurers about $90 — below the fair price — a good deal. Located in Langhorne, PA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$84 - $3,742	9%
Blue Cross Blue Shieldmajor	$84 - $4,967	9%
Aetnamajor	$84 - $1,061	9%
Cignamajor	$84 - $4,432	9%
Humanamajor	$84 - $428	9%
Kaiser Permanentemajor	$122	13%
Ambetter (Centene)	$90 - $1,790	9%
AmeriHealth	$122 - $2,213	13%
Clover Health	$84	9%
GEHA	$135 - $3,742	14%
Health Net	$90 - $97	9%
HealthPartners	$90 - $114	9%
Meridian	$84 - $90	9%
Molina	$90	9%
Oscar Health	$127 - $1,805	13%
Paramount	$90	9%
Presbyterian	$84 - $90	9%
Tufts Health Plan	$90	9%
UPMC Health Plan	$4,432	466%
WellMed	$84	9%
WellSense	$90	9%
+ 337 smaller / regional plans	$68 - $2,581

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 16 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 45378.

Insurance Before you use insurance

Call your insurance company to confirm St Mary Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 45378.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at St Mary Medical Center

Compare: Colonoscopy (diagnostic) at other PA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.