Colonoscopy (diagnostic)
Facility: Physicians Care Surgical Hospital
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $2,311
- Cash Discount Price: $5,441
- vs. Medicare Baseline: 2.43x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 243% of the Medicare baseline (a markup of 143%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Humana | $537 - $12,772 | 57% |
| Tricare | $537 - $12,772 | 57% |
| Connecticare | $819 - $19,575 | 86% |
| Personal Choice 65 | $831 - $12,363 | 87% |
| Medicare (plans) | $831 - $12,772 | 87% |
| Vibra Health Plan | $831 - $12,772 | 87% |
| Ibc Security 65 | $831 - $12,363 | 87% |
| Keystone 65 HMO | $831 - $12,772 | 87% |
| Devon Health Services | $831 - $12,772 | 87% |
| Pcsh Aarp | $831 - $12,772 | 87% |
| Shenandoah Life | $831 - $12,772 | 87% |
| Aetna | $831 - $23,230 | 87% |
| Unified Health Services | $831 - $12,772 | 87% |
| Aarp | $831 - $12,772 | 87% |
| UnitedHealthcare | $831 - $27,099 | 87% |
| Gpm Health and Life Insurance Mc Supplement | $831 - $12,772 | 87% |
| Cigna | $831 - $18,977 | 87% |
| Blue Cross Blue Shield | $831 - $23,941 | 87% |
| Pcsh Ibc | $898 - $18,753 | 95% |
| Amerihealth New Jersey HMO | $898 - $18,753 | 95% |
| Ibc - Local | $898 - $18,753 | 95% |
| Keystone Direct POS | $898 - $18,753 | 95% |
| Regence Blue Shield | $898 - $18,753 | 95% |
| Ibc 2021 | $898 - $18,753 | 95% |
| Horizon of New Jersey | $898 - $18,753 | 95% |
| Keystone HMO | $898 - $18,753 | 95% |
| Empire Plan | $898 - $18,753 | 95% |
| Amerihealth Administrators | $898 - $18,753 | 95% |
| Keystone Healthplan East | $898 - $18,753 | 95% |
| Independence Federal | $898 - $18,753 | 95% |
| Personal Choice | $898 - $18,753 | 95% |
| Ibc Local | $898 - $18,753 | 95% |
| Independence Administrators | $898 - $18,753 | 95% |
| Carefirst Administrators | $898 - $18,753 | 95% |
| Ibc | $898 - $18,753 | 95% |
| Independence Bc | $898 - $18,753 | 95% |
| Keystone First Vip Choice | $900 - $2,850 | 95% |
| Medicaid / KanCare | $900 - $2,850 | 95% |
| Straight Access | $900 - $2,850 | 95% |
| Keystone First | $900 - $2,850 | 95% |
| Keystone First Healthplan | $900 - $2,850 | 95% |
| PA Health and Wellness | $900 - $2,850 | 95% |
| Highmark | $1,612 - $23,941 | 170% |
| Allsavers | $1,763 - $27,099 | 186% |
| Surest | $1,763 - $27,099 | 186% |
| Oxford Health Plan | $1,763 - $27,099 | 186% |
| Golden Rule Op | $1,763 - $27,099 | 186% |
| Oxford Life Insurance Company | $1,763 - $27,099 | 186% |
| UPMC | $2,069 - $19,295 | 218% |
| Sana Benefits | $2,217 - $18,977 | 233% |
| Loomis | $2,217 - $18,977 | 233% |
| Cwi Benefits | $2,217 - $18,977 | 233% |
| Freedom Life Insurance Company | $2,217 - $18,977 | 233% |
| Apwu | $2,217 - $18,977 | 233% |
| Nalc Health | $2,217 - $18,977 | 233% |
| Health Partners | $2,217 - $18,977 | 233% |
| Healthgram | $2,217 - $18,977 | 233% |
| Central PA Teamsters | $2,243 - $21,231 | 236% |
| Allied Benefit Systems | $2,311 - $23,230 | 243% |
| Continental Benefits | $2,311 - $23,230 | 243% |
| Healthez | $2,311 - $23,230 | 243% |
| Ag Administrators Inc | $2,311 - $23,230 | 243% |
| Meritain Health | $2,311 - $23,230 | 243% |
| Coventry | $2,311 - $23,230 | 243% |
| Lucent Health | $2,311 - $23,230 | 243% |
| Ag Administrators | $2,311 - $23,230 | 243% |
| Allied Benefits Systems | $2,311 - $23,230 | 243% |
| Marpai Health | $2,311 - $23,230 | 243% |
| Trustmark | $2,311 - $23,230 | 243% |
| Premier Care Network | $2,311 - $23,230 | 243% |
| Geha | $2,311 - $23,230 | 243% |