CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: UPMC Muncy

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,458
Cash Discount Price: $1,654
vs. Medicare Baseline: 1.53x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at UPMC Muncy is $1,458. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,654. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.53x the Medicare baseline. Located in 215 East Water Street, Muncy, PA.

Cash / Self-Pay

$1,654

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,458

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: $1,654 (174%)

Insurance Median: $1,458 (153%)

Cash: $1,654 (174% of Medicare)

Ins. Median: $1,458 (153% 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
Geisinger	$199 - $1,847	21%
Upmc Health Plan	$199 - $1,202	21%
Highmark Wholecare (Prev Gateway)	$201 - $413	21%
Amerihealth Caritas	$204 - $2,208	21%
Pa Health & Wellness	$308 - $2,316	32%
Cigna	$434 - $1,888	46%
UnitedHealthcare	$442 - $1,885	47%
Upmc Work Partners	$781	82%
Three Rivers Provider Network	$835 - $2,480	88%
Blue Cross Blue Shield	$1,081 - $1,273	114%
Aetna	$1,118 - $1,819	118%
Coventry/First Health	$1,381 - $1,855	145%
Wirerope Works	$1,532	161%
Multiplan	$2,150 - $2,618	226%
America'S Choice	$2,205	232%
Intergroup	$2,205	232%

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 $1,654.
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 UPMC Muncy 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.