CMS Price Transparency Data

Colonoscopy with biopsy

Facility: UPMC St Margaret

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,272
Cash Discount Price: $4,868
vs. Medicare Baseline: 1.86x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at UPMC St Margaret is $2,272. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,868. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.86x the Medicare baseline. Located in 815 Freeport Road, Pittsburgh, PA.

Cash / Self-Pay

$4,868

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,272

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: $4,868 (398%)

Insurance Median: $2,272 (186%)

Cash: $4,868 (398% of Medicare)

Ins. Median: $2,272 (186% 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 - $1,032	20%
Highmark Wholecare (Prev Gateway)	$334 - $1,214	27%
Amerihealth Caritas	$352	29%
Pa Health & Wellness	$384 - $1,214	31%
Blue Cross Blue Shield	$737 - $4,394	60%
Upmc Work Partners	$879	72%
Aetna	$1,180 - $3,245	97%
Cigna	$2,272 - $3,245	186%
Coventry/First Health	$5,679	465%
Private Health Care Systems	$6,490	531%
Selectcare	$6,490	531%
Humana	$6,896	564%

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 $4,868.
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 St Margaret 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.