CMS Price Transparency Data

Colonoscopy with biopsy

Facility: UPMC Hamot

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,550
Cash Discount Price: $3,099
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at UPMC Hamot is $1,550. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,099. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.27x the Medicare baseline. Located in 201 State Street, Erie, PA.

Cash / Self-Pay

$3,099

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,550

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: $3,099 (253%)

Insurance Median: $1,550 (127%)

Cash: $3,099 (253% of Medicare)

Ins. Median: $1,550 (127% 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
Upmc Health Plan	$248 - $2,854	20%
UnitedHealthcare	$259 - $1,535	21%
Aetna	$270 - $3,616	22%
Geisinger	$313	26%
Highmark Wholecare (Prev Gateway)	$334 - $1,401	27%
Health Partners Plans (Jefferson Health Plan)	$340	28%
Amerihealth Caritas	$352 - $1,401	29%
Pa Health & Wellness	$384 - $1,401	31%
Blue Cross Blue Shield	$730 - $3,528	60%
Univera	$775 - $2,273	63%
Upmc Work Partners	$879	72%
Fidelis	$1,297	106%
Wellcare	$1,336	109%
Cigna	$1,401 - $2,066	115%
Independent Health	$1,635 - $1,853	134%
Intergroup	$3,357 - $4,132	275%
Multiplan	$3,616 - $4,132	296%

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 $3,099.
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 Hamot 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.