CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Geisinger Wyoming Valley Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,958
Cash Discount Price: $2,740
vs. Medicare Baseline: 1.60x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Geisinger Wyoming Valley Medical Center is $1,958. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,740. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.60x the Medicare baseline. Located in 1000 East Mountain Boulevard, Wilkes Barre, PA.

Cash / Self-Pay

$2,740

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,958

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: $2,740 (224%)

Insurance Median: $1,958 (160%)

Cash: $2,740 (224% of Medicare)

Ins. Median: $1,958 (160% 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	$232	19%
Amerihealth	$259	21%
Upmc For You	$265	22%
Health Partners	$270	22%
Upmc Chip	$282	23%
Blue Cross Blue Shield	$715 - $1,176	58%
Geisinger Health Plan	$1,165 - $3,572	95%
Humana	$1,165	95%
Life Geisinger	$1,165	95%
Medicare (plans)	$1,165 - $1,316	95%
Prison Health Services	$1,165	95%
Cigna	$1,913 - $2,002	156%
Aetna	$2,057 - $2,952	168%
Christian Healthcare Ministries	$2,210	181%
UnitedHealthcare	$2,258	185%
Wyoming Seminary	$3,093	253%
Intergroup Services	$3,756	307%
Multiplan	$3,756	307%
Ambetter / Centene	$3,843	314%

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 $2,740.
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 Wyoming Valley Medical Center 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.