CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Penn State Health Lancaster Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,204
Cash Discount Price: $2,222
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Penn State Health Lancaster Medical Center is $1,204. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,222. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.98x the Medicare baseline. Located in 2160 State Road, Lancaster, PA.

Cash / Self-Pay

$2,222

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,204

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: $2,222 (182%)

Insurance Median: $1,204 (98%)

Cash: $2,222 (182% of Medicare)

Ins. Median: $1,204 (98% 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
[Amerihealth Caritas]	$998 - $1,174	82%
[Highmark Wholecare]	$998 - $1,174	82%
[Geisinger]	$1,057 - $5,107	86%
[Health Partners Plans]	$1,092 - $1,198	89%
[Pa Health & Wellness]	$1,098 - $1,209	90%
[Highmark]	$1,162 - $5,132	95%
UnitedHealthcare	$1,174 - $4,798	96%
[Cbc]	$1,174 - $3,857	96%
Aetna	$1,186 - $4,605	97%
Humana	$1,186	97%
[Healthspring]	$1,186	97%
[Upmc]	$1,198 - $5,662	98%
[Point Comfort Underwriters]	$1,468	120%
[Highmark Choice Blue]	$4,105	336%
[Highmark Aca]	$4,311	353%
Cigna	$4,702	385%
[First Health]	$6,131	501%
[Multiplan]	$6,131	501%

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 $2,222.
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 Penn State Health Lancaster 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.