CMS Price Transparency Data

Colonoscopy with biopsy

Facility: UPMC Muncy

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,716
Cash Discount Price: $3,253
vs. Medicare Baseline: 2.22x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at UPMC Muncy is $2,716. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,253. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 2.22x the Medicare baseline. Located in 215 East Water Street, Muncy, PA.

Cash / Self-Pay

$3,253

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,716

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: $3,253 (266%)

Insurance Median: $2,716 (222%)

Cash: $3,253 (266% of Medicare)

Ins. Median: $2,716 (222% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 222% of the Medicare baseline (a markup of 122%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$248 - $3,632	20%
Upmc Health Plan	$248 - $2,364	20%
Highmark Wholecare (Prev Gateway)	$251 - $813	21%
Amerihealth Caritas	$254 - $2,208	21%
Pa Health & Wellness	$384 - $2,316	31%
UnitedHealthcare	$410 - $3,708	34%
Cigna	$854 - $3,713	70%
Upmc Work Partners	$879	72%
Three Rivers Provider Network	$940 - $4,879	77%
Blue Cross Blue Shield	$2,126 - $2,504	174%
Aetna	$2,198 - $3,578	180%
Coventry/First Health	$2,716 - $3,648	222%
Wirerope Works	$3,014	247%
Multiplan	$4,228 - $5,150	346%
America'S Choice	$4,337	355%
Intergroup	$4,337	355%

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 $3,253.
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 UPMC Muncy 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.