CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Roxborough Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,108
Cash Discount Price: $950
vs. Medicare Baseline: 1.17x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Roxborough Memorial Hospital is $1,108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $950. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.17x the Medicare baseline. Located in 5800 Ridge Ave, Philadelphia, PA.

Cash / Self-Pay

$950

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,108

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: $950 (100%)

Insurance Median: $1,108 (117%)

Cash: $950 (100% of Medicare)

Ins. Median: $1,108 (117% 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

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
Keystone	$191 - $3,634	20%
Medicaid / KanCare	$443	47%
Humana	$761	80%
Blue Cross Blue Shield	$951 - $2,523	100%
Health Partners Plan	$951 - $1,582	100%
Medicare (plans)	$951 - $998	100%
Pa Health & Wellness	$951 - $3,500	100%
Tricare	$951	100%
UnitedHealthcare	$951 - $2,040	100%
Providers Partner Health Plan	$979	103%
Spartan	$998	105%
Auto Insurance	$1,046	110%
Worker Compensation	$1,074	113%
Employer Direct Healthcare	$1,331	140%
Naphcare	$1,474	155%
Highmark	$2,072	218%
Cigna	$2,248	237%

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 $950.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Roxborough Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45378.
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.