CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Geisinger-Community Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,032
Cash Discount Price: $2,519
vs. Medicare Baseline: 2.14x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Geisinger-Community Medical Center is $2,032. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,519. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.14x the Medicare baseline. Located in 1822 Mulberry Street, Scranton, PA.

Cash / Self-Pay

$2,519

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,032

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: $2,519 (265%)

Insurance Median: $2,032 (214%)

Cash: $2,519 (265% of Medicare)

Ins. Median: $2,032 (214% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 214% of the Medicare baseline (a markup of 114%). 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
Medicaid / KanCare	$180	19%
Geisinger Family Plan	$186	20%
Amerihealth	$208	22%
Upmc For You	$212	22%
Health Partners	$217	23%
Upmc Chip	$226	24%
Blue Cross Blue Shield	$317 - $4,784	33%
Geisinger Health Plan	$900 - $2,589	95%
Medicare (plans)	$900	95%
Prison Health Services	$900	95%
Humana	$919	97%
Aetna	$946 - $2,397	100%
Cigna	$1,792	189%
Christian Healthcare Ministries	$2,032	214%
Healthnet	$2,381	251%
Universal Managed Care	$2,519 - $2,641	265%
Ambetter / Centene	$2,972	313%
Intergroup Services	$3,250 - $3,657	342%
Multiplan	$3,454	364%
UnitedHealthcare	$7,139	751%

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 $2,519.
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 Geisinger-Community Medical Center 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.