CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Excela Health - Frick Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,241
Cash Discount Price: $1,500
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Excela Health - Frick Hospital is $1,241. 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 $1,222.56, this hospital’s rate is 1.02x the Medicare baseline. Located in 508 South Church Street, Mount Pleasant, PA.

Cash / Self-Pay

$1,500

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,241

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: $1,500 (123%)

Insurance Median: $1,241 (102%)

Cash: $1,500 (123% of Medicare)

Ins. Median: $1,241 (102% 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
Geisinger	$384 - $1,224	31%
Health Partners Plans	$384	31%
Highmark Wholecare	$394 - $1,270	32%
Upmc	$406 - $1,259	33%
Upmc For Kids Chip	$411	34%
Amerihealth Caritas	$416 - $1,224	34%
Pa Health And Wellness	$416 - $1,247	34%
Highmark Advantage Community Blue	$1,085	89%
Va	$1,166	95%
Aetna	$1,201 - $2,681	98%
Health Partners Plan	$1,201	98%
Martin'S Point	$1,201	98%
Peak Health	$1,201 - $2,739	98%
Humana	$1,212	99%
United	$1,212	99%
Senior Life	$1,223	100%
Cigna	$1,224 - $2,700	100%
Devoted	$1,224	100%
The Health Plan Of West Virginia	$1,236 - $2,739	101%
American Health Plan Of Pa	$1,282	105%
Provider Network Of America	$1,282 - $2,000	105%
Provider Plan Partners Plan	$1,282	105%
Upmc Health Plan	$1,352 - $1,806	111%
Highmark Children'S Health Insurance Program	$1,402	115%
Ambetter / Centene	$1,457	119%
Highmark	$1,577 - $2,572	129%
Velocity	$1,748	143%
Community Blue	$2,315	189%
UnitedHealthcare	$3,116	255%

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: 45380.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Excela Health - Frick Hospital 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.