CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Chan Soon- Shiong Medical Center at Windber

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $451
Cash Discount Price: $598
vs. Medicare Baseline: 0.37x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Chan Soon- Shiong Medical Center at Windber is $451. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $598. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.37x the Medicare baseline. Located in 600 Somerset Avenue, Windber, PA.

Cash / Self-Pay

$598

Average discount available for prompt cash payment at this facility.

Insurance Median

$451

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: $598 (49%)

Insurance Median: $451 (37%)

Cash: $598 (49% of Medicare)

Ins. Median: $451 (37% 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
Highmark	$150 - $2,288	12%
Aetna	$191 - $1,147	16%
Amerihealth Caritas	$237 - $1,147	19%
Geisinger	$241 - $1,923	20%
Highmark Wholecare	$264	22%
Upmc Health Plan	$264 - $1,641	22%
Pa Health & Wellness	$270 - $1,147	22%
United	$281 - $1,737	23%
Cigna	$422 - $450	35%
Humana	$443 - $1,147	36%
Senior Life	$450 - $1,166	37%
Va Ccn	$450 - $1,166	37%

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 $598.
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 Chan Soon- Shiong Medical Center at Windber 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.