CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: UPMC Chautauqua at Wca

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,383
Cash Discount Price: $1,500
vs. Medicare Baseline: 1.46x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at UPMC Chautauqua at Wca is $1,383. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,500. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.46x the Medicare baseline. Located in 207 Foote Avenue, Jamestown, NY.

Cash / Self-Pay

$1,500

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,383

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: $1,500 (158%)

Insurance Median: $1,383 (146%)

Cash: $1,500 (158% of Medicare)

Ins. Median: $1,383 (146% 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
Univera	$154 - $207	16%
Upmc Health Plan	$226 - $1,500	24%
Geisinger	$251	26%
Health Partners Plans (Jefferson Health Plan)	$272	29%
Magnacare	$652 - $1,875	69%
Blue Cross Blue Shield	$1,034 - $1,987	109%
Independent Health	$1,092 - $1,373	115%
Beacon	$1,114 - $1,392	117%
Fidelis	$1,114	117%
Humana	$1,114 - $2,000	117%
United Behavioral Health	$1,114	117%
UnitedHealthcare	$1,114 - $1,625	117%
Wellcare	$1,147	121%
Aetna	$1,159 - $1,625	122%
Multiplan	$1,875	197%
Ghi/Emblem Health	$2,000	211%
Statewide Independent Ppo	$2,200	232%
Affordable First Health	$2,250	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 $1,500.
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 UPMC Chautauqua at Wca 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.