CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Geisinger-Lewistown Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,902
Cash Discount Price: $2,427
vs. Medicare Baseline: 1.56x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Geisinger-Lewistown Hospital is $1,902. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,427. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.56x the Medicare baseline. Located in 400 Highland Avenue, Lewistown, PA.

Cash / Self-Pay

$2,427

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,902

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: $2,427 (199%)

Insurance Median: $1,902 (156%)

Cash: $2,427 (199% of Medicare)

Ins. Median: $1,902 (156% 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
Medicaid / KanCare	$225	18%
Geisinger Family Plan	$241	20%
Amerihealth	$248	20%
Upmc Health Plan	$265 - $11,890	22%
Health Partners	$270	22%
Upmc Chip	$282	23%
Blue Cross Blue Shield	$1,144 - $3,450	94%
Geisinger Health Plan	$1,144 - $5,360	94%
Medicare (plans)	$1,144	94%
Advantra	$1,155	94%
Humana	$1,155	94%
Aetna	$1,599 - $1,902	131%
Cigna	$1,693 - $2,059	138%
UnitedHealthcare	$1,734	142%
Christian Healthcare Ministries	$1,957	160%
Ambetter / Centene	$2,744	224%
Christian Health Aid	$3,131	256%
Three Rivers Provider Network Inc.	$3,131	256%
Multiplan	$3,327	272%
Healthsmart Payors Organization	$3,523	288%

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 $2,427.
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 Geisinger-Lewistown 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.