CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: UPMC Mercy

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,000
Cash Discount Price: $1,500
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at UPMC Mercy is $1,000. 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 1.05x the Medicare baseline. Located in 1400 Locust Street, Pittsburgh, PA.

Cash / Self-Pay

$1,500

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,000

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: $1,000 (105%)

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

Ins. Median: $1,000 (105% 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
Upmc Health Plan	$199 - $2,316	21%
UnitedHealthcare	$208	22%
Highmark Wholecare (Prev Gateway)	$268 - $939	28%
Amerihealth Caritas	$286 - $939	30%
Pa Health & Wellness	$308 - $939	32%
Private Health Care Systems	$596	63%
Aetna	$698 - $1,000	73%
Blue Cross Blue Shield	$730 - $4,521	77%
Upmc Work Partners	$797	84%
Cigna	$850 - $1,500	89%
Bravo	$875	92%
Coventry/First Health	$1,100	116%
Intergroup	$1,250 - $2,000	132%
American Healthcare Group	$2,000	211%
National Provider Network	$2,050	216%
Health Payors Organization	$2,250	237%
Multiplan	$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 Mercy 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.