CMS Price Transparency Data

Colonoscopy with biopsy

Facility: West Penn Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $345
Cash Discount Price: $150
vs. Medicare Baseline: 0.28x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at West Penn Hospital is $345. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $150. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.28x the Medicare baseline. Located in 4800 Friendship Avenue, Pittsburgh, PA.

Cash / Self-Pay

$150

Average discount available for prompt cash payment at this facility.

Insurance Median

$345

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: $150 (12%)

Insurance Median: $345 (28%)

Cash: $150 (12% of Medicare)

Ins. Median: $345 (28% 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
Highmark	$173 - $2,879	14%
Life Pittsburgh	$186 - $1,134	15%
Medicare (plans)	$197 - $1,168	16%
American Health Plans	$204 - $1,134	17%
Amerihealth	$237 - $1,191	19%
University Of Pittsburgh Medical Center	$248 - $352	20%
Aetna	$270 - $3,755	22%
Pennsylvania Health And Wellness	$298 - $480	24%
Highmark Wholecare	$311 - $1,202	25%
Cigna	$315 - $3,764	26%
Geisinger	$327 - $512	27%
UnitedHealthcare	$327 - $3,980	27%
Martin'S Point	$1,134	93%
Humana	$1,202	98%
Molina	$1,236	101%
Medical Mutual	$3,764	308%

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 $150.
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 West Penn 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.