CMS Price Transparency Data

Colonoscopy with biopsy

Facility: UPMC McKeesport Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,964
Cash Discount Price: $3,034
vs. Medicare Baseline: 1.61x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at UPMC McKeesport Hospital is $1,964. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,034. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.61x the Medicare baseline. Located in 1500 Fifth Avenue, Mc Keesport, PA.

Cash / Self-Pay

$3,034

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,964

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: $3,034 (248%)

Insurance Median: $1,964 (161%)

Cash: $3,034 (248% of Medicare)

Ins. Median: $1,964 (161% 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
UnitedHealthcare	$248	20%
Upmc Health Plan	$248 - $2,299	20%
Highmark Wholecare (Prev Gateway)	$334 - $1,214	27%
Amerihealth Caritas	$352 - $1,214	29%
Pa Health & Wellness	$384 - $1,214	31%
Blue Cross Blue Shield	$737 - $3,720	60%
Upmc Work Partners	$879	72%
Aetna	$1,180 - $2,022	97%
Cigna	$1,947 - $3,034	159%
Intergroup	$2,528	207%
Coventry/First Health	$3,539	289%
Private Health Care Systems	$4,045	331%
Selectcare	$4,045	331%
Humana	$4,298	352%

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 $3,034.
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 UPMC McKeesport 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.