CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Geisinger Wyoming Valley Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,800
Cash Discount Price: $2,519
vs. Medicare Baseline: 1.89x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Geisinger Wyoming Valley Medical Center is $1,800. 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 1.89x the Medicare baseline. Located in 1000 East Mountain Boulevard, Wilkes Barre, PA.

Cash / Self-Pay

$2,519

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,800

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: $1,800 (189%)

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

Ins. Median: $1,800 (189% 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.

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	$657 - $943	69%
Geisinger Health Plan	$900 - $2,762	95%
Humana	$900	95%
Life Geisinger	$900	95%
Medicare (plans)	$900 - $1,018	95%
Prison Health Services	$900	95%
Cigna	$1,759 - $1,841	185%
Aetna	$1,892 - $2,714	199%
Christian Healthcare Ministries	$2,032	214%
UnitedHealthcare	$2,076	219%
Wyoming Seminary	$2,844	299%
Ambetter / Centene	$2,972	313%
Intergroup Services	$3,454	364%
Multiplan	$3,454	364%

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 Wyoming Valley 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.