CMS Price Transparency Data

Colonoscopy with biopsy

Facility: UPMC Wellsboro

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,106
Cash Discount Price: $3,253
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at UPMC Wellsboro is $1,106. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,253. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.90x the Medicare baseline. Located in 32-36 Central Avenue, Wellsboro, PA.

Cash / Self-Pay

$3,253

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,106

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: $3,253 (266%)

Insurance Median: $1,106 (90%)

Cash: $3,253 (266% of Medicare)

Ins. Median: $1,106 (90% 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
Aetna	$109 - $4,678	9%
Blue Cross Blue Shield	$121 - $2,741	10%
Highmark Wholecare (Prev Gateway)	$121 - $1,084	10%
Upmc Health Plan	$123 - $2,364	10%
Cigna	$127 - $1,138	10%
Pa Health & Wellness	$131 - $1,171	11%
Amerihealth Caritas	$248	20%
Geisinger	$248 - $3,632	20%
Wirerope Works	$336 - $3,014	27%
Health Partners Plans (Jefferson Health Plan)	$340	28%
UnitedHealthcare	$410 - $4,608	34%
Multiplan	$472 - $5,150	39%
America'S Choice	$544 - $4,879	44%
Intergroup	$544 - $4,879	44%
Upmc Work Partners	$841	69%

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 $3,253.
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 Wellsboro 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.