CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Grove City Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $255
Cash Discount Price: $118
vs. Medicare Baseline: 0.27x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Grove City Medical Center is $255. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $118. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.27x the Medicare baseline. Located in 631 North Broad Street Ext., Grove City, PA.

Cash / Self-Pay

$118

Average discount available for prompt cash payment at this facility.

Insurance Median

$255

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: $118 (12%)

Insurance Median: $255 (27%)

Cash: $118 (12% of Medicare)

Ins. Median: $255 (27% 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
Univera	$74 - $265	8%
Highmark	$80 - $1,811	8%
Allwell	$86 - $171	9%
Life Pittsburgh	$86 - $877	9%
Medicare (plans)	$91 - $903	10%
American Health Plans	$94 - $877	10%
Aetna	$180 - $1,866	19%
Amerihealth	$190 - $921	20%
University Of Pittsburgh Medical Center	$208 - $974	22%
Pennsylvania Health And Wellness	$238 - $664	25%
Highmark Wholecare	$249 - $930	26%
Geisinger	$262 - $709	28%
UnitedHealthcare	$262 - $2,658	28%
Cigna	$290 - $2,497	31%
Humana	$930	98%
Molina	$956	101%
Medical Mutual	$2,497	263%

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 $118.
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 Grove City Medical Center 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.