CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: UPMC Williamsport

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,193
Cash Discount Price: $1,500
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at UPMC Williamsport is $1,193. 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 1.26x the Medicare baseline. Located in 700 High Street, Williamsport, PA.

Cash / Self-Pay

$1,500

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,193

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: $1,193 (126%)

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

Ins. Median: $1,193 (126% 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
Geisinger	$199 - $1,675	21%
Upmc Health Plan	$199 - $1,090	21%
Amerihealth Caritas	$204 - $895	21%
Highmark Wholecare (Prev Gateway)	$254 - $939	27%
Pa Health & Wellness	$308 - $939	32%
UnitedHealthcare	$567 - $1,710	60%
Aetna	$675 - $1,650	71%
Upmc Work Partners	$781	82%
Three Rivers Provider Network	$835 - $2,250	88%
Multiplan	$863 - $1,950	91%
Blue Cross Blue Shield	$878 - $1,172	92%
Coventry/First Health	$1,252 - $1,682	132%
Wirerope Works	$1,390	146%
Cigna	$1,712	180%
America'S Choice	$2,000	211%
Intergroup	$2,000	211%

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 Williamsport 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.