CMS Price Transparency Data
Colonoscopy with biopsy
Facility: Physicians Care Surgical Hospital
Billing Code: 45380 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45380
- Insurance Median: $2,311
- Cash Discount Price: $5,542
- vs. Medicare Baseline: 1.89x Medicare
The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Physicians Care Surgical Hospital is $2,311. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,542. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.89x the Medicare baseline. Located in 454 Enterprise Drive, Royersford, PA.
Cash / Self-Pay
$5,542
Average discount available for prompt cash payment at this facility.
Insurance Median
$2,311
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: $5,542 (453%)
Insurance Median: $2,311 (189%)
Cash: $5,542 (453% of Medicare)
Ins. Median: $2,311 (189% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Tricare | $592 - $12,772 | 48% |
| Humana | $592 - $12,772 | 48% |
| Medicaid / KanCare | $900 - $2,850 | 74% |
| Keystone First Vip Choice | $900 - $2,850 | 74% |
| Keystone First Healthplan | $900 - $2,850 | 74% |
| Keystone First | $900 - $2,850 | 74% |
| Straight Access | $900 - $2,850 | 74% |
| PA Health and Wellness | $900 - $2,850 | 74% |
| Connecticare | $1,078 - $19,575 | 88% |
| UnitedHealthcare | $1,083 - $27,099 | 89% |
| Keystone 65 HMO | $1,083 - $12,772 | 89% |
| Personal Choice 65 | $1,083 - $12,363 | 89% |
| Aarp | $1,083 - $12,772 | 89% |
| Shenandoah Life | $1,083 - $12,772 | 89% |
| Unified Health Services | $1,083 - $12,772 | 89% |
| Devon Health Services | $1,083 - $12,772 | 89% |
| Ibc Security 65 | $1,083 - $12,363 | 89% |
| Cigna | $1,083 - $18,977 | 89% |
| Blue Cross Blue Shield | $1,083 - $23,941 | 89% |
| Vibra Health Plan | $1,083 - $12,772 | 89% |
| Medicare (plans) | $1,083 - $12,772 | 89% |
| Aetna | $1,083 - $23,230 | 89% |
| Pcsh Aarp | $1,083 - $12,772 | 89% |
| Gpm Health and Life Insurance Mc Supplement | $1,083 - $12,772 | 89% |
| Ibc Local | $1,170 - $18,753 | 96% |
| Independence Bc | $1,170 - $18,753 | 96% |
| Regence Blue Shield | $1,170 - $18,753 | 96% |
| Amerihealth Administrators | $1,170 - $18,753 | 96% |
| Independence Administrators | $1,170 - $18,753 | 96% |
| Carefirst Administrators | $1,170 - $18,753 | 96% |
| Independence Federal | $1,170 - $18,753 | 96% |
| Pcsh Ibc | $1,170 - $18,753 | 96% |
| Personal Choice | $1,170 - $18,753 | 96% |
| Keystone Direct POS | $1,170 - $18,753 | 96% |
| Horizon of New Jersey | $1,170 - $18,753 | 96% |
| Ibc - Local | $1,170 - $18,753 | 96% |
| Ibc | $1,170 - $18,753 | 96% |
| Keystone Healthplan East | $1,170 - $18,753 | 96% |
| Ibc 2021 | $1,170 - $18,753 | 96% |
| Empire Plan | $1,170 - $18,753 | 96% |
| Amerihealth New Jersey HMO | $1,170 - $18,753 | 96% |
| Keystone HMO | $1,170 - $18,753 | 96% |
| UPMC | $2,069 - $19,295 | 169% |
| Highmark | $2,081 - $23,941 | 170% |
| Healthgram | $2,217 - $18,977 | 181% |
| Nalc Health | $2,217 - $18,977 | 181% |
| Loomis | $2,217 - $18,977 | 181% |
| Freedom Life Insurance Company | $2,217 - $18,977 | 181% |
| Sana Benefits | $2,217 - $18,977 | 181% |
| Apwu | $2,217 - $18,977 | 181% |
| Cwi Benefits | $2,217 - $18,977 | 181% |
| Health Partners | $2,217 - $18,977 | 181% |
| Central PA Teamsters | $2,243 - $21,231 | 183% |
| Surest | $2,298 - $27,099 | 188% |
| Allsavers | $2,298 - $27,099 | 188% |
| Oxford Life Insurance Company | $2,298 - $27,099 | 188% |
| Oxford Health Plan | $2,298 - $27,099 | 188% |
| Golden Rule Op | $2,298 - $27,099 | 188% |
| Allied Benefits Systems | $2,311 - $23,230 | 189% |
| Coventry | $2,311 - $23,230 | 189% |
| Marpai Health | $2,311 - $23,230 | 189% |
| Ag Administrators | $2,311 - $23,230 | 189% |
| Lucent Health | $2,311 - $23,230 | 189% |
| Geha | $2,311 - $23,230 | 189% |
| Allied Benefit Systems | $2,311 - $23,230 | 189% |
| Healthez | $2,311 - $23,230 | 189% |
| Ag Administrators Inc | $2,311 - $23,230 | 189% |
| Meritain Health | $2,311 - $23,230 | 189% |
| Continental Benefits | $2,311 - $23,230 | 189% |
| Premier Care Network | $2,311 - $23,230 | 189% |
| Trustmark | $2,311 - $23,230 | 189% |