CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: UPMC Kane

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $729
Cash Discount Price: $746
vs. Medicare Baseline: 0.77x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at UPMC Kane is $729. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $746. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.77x the Medicare baseline. Located in 4372 Route 6, Kane, PA.

Cash / Self-Pay

$746

Average discount available for prompt cash payment at this facility.

Insurance Median

$729

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: $746 (79%)

Insurance Median: $729 (77%)

Cash: $746 (79% of Medicare)

Ins. Median: $729 (77% 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
UPMC Health Plan	$199 - $2,316	21%
Aetna	$199 - $479	21%
UnitedHealthcare	$208 - $609	22%
Geisinger	$251	26%
Highmark Wholecare (Prev Gateway)	$268 - $473	28%
Amerihealth Caritas	$282 - $497	30%
PA Health & Wellness	$308	32%
Blue Cross Blue Shield	$460 - $1,740	48%
UPMC Work Partners	$729	77%
Focus Healthcare	$805 - $1,182	85%
Horizon Health Plan	$871	92%
Cigna	$871 - $28,005	92%
Multiplan	$933	98%
Health Coalition Partners	$995	105%
Intergroup	$995	105%

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 $746.
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 Kane 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.