CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Independence Health System Butler Memorial Hospita

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $921
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Independence Health System Butler Memorial Hospita is $921. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.97x the Medicare baseline. Located in One Hospital Way, Butler, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$921

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%)

Insurance Median: $921 (97%)

Ins. Median: $921 (97% 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%
UnitedHealthcare	$180 - $2,249	19%
Geisinger	$197 - $921	21%
Amerihealth	$199 - $921	21%
Jefferson Health Plan	$199	21%
Gateway	$204 - $985	21%
Upmc	$204 - $1,819	21%
Aetna	$208 - $2,045	22%
Ccbh - Behavioral Health	$432	45%
Pnoa	$758 - $965	80%
Workers Comp	$824	87%
Highmark	$860 - $1,850	91%
Life Butler County	$877	92%
Martin'S Point - Usfhp	$877	92%
Medicare (plans)	$877	92%
Peak Health	$877 - $2,061	92%
Provider Partners	$877	92%
Tricare	$877	92%
Humana	$912	96%
Devoted Health Plan	$930	98%
The Health Plan	$930 - $2,061	98%
Pa Health & Wellness	$938	99%
American Health Plan	$965	102%
Highmark Aca - Direct Blue	$1,156	122%
Ellwood Group	$1,754	185%
Highmark Community Blue	$1,814	191%
Cigna	$2,004	211%
Highmark - Ind.& Managed Care	$2,056	216%

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 $X.
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 Independence Health System Butler Memorial Hospita 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.