CMS Price Transparency Data

Colonoscopy with biopsy

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $4,027
Cash Discount Price: $5,141
vs. Medicare Baseline: 3.29x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at UPMC Children's Hospital of Pittsburgh is $4,027. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,141. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 3.29x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$5,141

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,027

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: $5,141 (421%)

Insurance Median: $4,027 (329%)

Cash: $5,141 (421% of Medicare)

Ins. Median: $4,027 (329% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 329% of the Medicare baseline (a markup of 229%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$204 - $4,712	17%
Upmc Health Plan	$520 - $2,852	43%
Health Plan Of Upper Ohio Valley	$673 - $5,569	55%
Amerihealth Caritas	$844 - $1,214	69%
Health Partners Plans (Jefferson Health Plan)	$872	71%
Highmark Wholecare (Prev Gateway)	$910	74%
Pa Health & Wellness	$914	75%
Geisinger	$927 - $3,851	76%
Blue Cross Blue Shield	$1,193 - $3,125	98%
Cigna	$1,214 - $4,712	99%
UnitedHealthcare	$1,270 - $4,027	104%
Intergroup	$5,569 - $7,283	456%
Coventry/First Health	$6,854	561%
Saudi Armed Forces	$6,854	561%
Health Payors Organization	$7,283	596%
Multiplan	$7,283	596%
National Provider Network	$7,711	631%
Private Health Care Systems	$7,711	631%

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 $5,141.
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 Children's Hospital of Pittsburgh 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.