CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Roxborough Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,425
Cash Discount Price: $1,223
vs. Medicare Baseline: 1.17x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Roxborough Memorial Hospital is $1,425. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,223. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.17x the Medicare baseline. Located in 5800 Ridge Ave, Philadelphia, PA.

Cash / Self-Pay

$1,223

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,425

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: $1,223 (100%)

Insurance Median: $1,425 (117%)

Cash: $1,223 (100% of Medicare)

Ins. Median: $1,425 (117% 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
Keystone	$239 - $3,634	20%
Medicaid / KanCare	$320	26%
Humana	$979	80%
Blue Cross Blue Shield	$1,223 - $2,523	100%
Health Partners Plan	$1,223 - $1,835	100%
Medicare (plans)	$1,223 - $1,285	100%
Pa Health & Wellness	$1,223 - $3,500	100%
Tricare	$1,223	100%
UnitedHealthcare	$1,223 - $2,557	100%
Providers Partner Health Plan	$1,260	103%
Spartan	$1,285	105%
Auto Insurance	$1,346	110%
Worker Compensation	$1,382	113%
Employer Direct Healthcare	$1,713	140%
Naphcare	$1,896	155%
Highmark	$2,666	218%
Cigna	$2,893	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 $1,223.
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 Roxborough Memorial 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.