CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,375
Cash Discount Price: $1,500
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at UPMC Children's Hospital of Pittsburgh is $1,375. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,500. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.45x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$1,500

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,375

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: $1,500 (158%)

Insurance Median: $1,375 (145%)

Cash: $1,500 (158% of Medicare)

Ins. Median: $1,375 (145% 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
Aetna	$188 - $1,375	20%
Upmc Health Plan	$417 - $2,873	44%
Health Plan Of Upper Ohio Valley	$521 - $1,625	55%
Amerihealth Caritas	$676 - $939	71%
Health Partners Plans (Jefferson Health Plan)	$699	74%
Highmark Wholecare (Prev Gateway)	$728	77%
Pa Health & Wellness	$732	77%
Geisinger	$742 - $1,124	78%
Blue Cross Blue Shield	$922 - $3,125	97%
Cigna	$939 - $1,375	99%
UnitedHealthcare	$1,000 - $1,759	105%
Intergroup	$1,625 - $2,125	171%
Coventry/First Health	$2,000	211%
Saudi Armed Forces	$2,000	211%
Health Payors Organization	$2,125	224%
Multiplan	$2,125	224%
National Provider Network	$2,250	237%
Private Health Care Systems	$2,250	237%

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 $1,500.
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 Children's Hospital of Pittsburgh 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.