CMS Price Transparency Data

Colonoscopy with biopsy

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 45380 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,362

about 1.1× the $1,223 Medicare rate · typically $520–$1,365

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,158

Below the fair price — a good deal

about $204 under the fair price · 0.9× Medicare

Medicare pays $1,223 Fair price $1,362 This hospital $1,158 Cash price $5,141 Hospital's list price $8,568

How we calculate the fair BaseRate →

How this hospital compares to other PA hospitals

Highest price of the 9 PA hospitals we have prices for — worth calling around.

Cheapest $225 Priciest $1,158

Black dot = this hospital, among the 9 PA hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Colonoscopy with biopsy is about $1,362 (about 1.1× the $1,223 Medicare rate). UPMC Children's Hospital of Pittsburgh charges insurers about $1,158, or about $5,141 in cash — below the fair price — a good deal. Located in Pittsburgh, PA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna HumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$1,270 - $4,027	104%
Blue Cross Blue Shieldmajor	$910 - $3,125	74%
Aetnamajor	$204 - $4,712	17%
Cignamajor	$1,214 - $4,712	99%
AmeriHealth	$844 - $1,214	69%
Geisinger	$927 - $3,851	76%
HealthPartners	$872	71%
UPMC Health Plan	$520 - $2,852	43%
+ 7 smaller / regional plans	$673 - $7,711

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 5,141), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 45380.

Insurance Before you use insurance

Call your insurance company to confirm UPMC Children's Hospital of Pittsburgh is in-network.
Ask your insurer whether prior approval is required for CPT code 45380.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at UPMC Children's Hospital of Pittsburgh

Compare: Colonoscopy with biopsy at other PA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.