CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Saint Joseph Regional Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 45378
  • Insurance Median: $1,476
  • Cash Discount Price: $6,286
  • vs. Medicare Baseline: 1.55x Medicare
The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Saint Joseph Regional Medical Center is $1,476. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,286. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.55x the Medicare baseline. Located in 5215 Holy Cross Pkwy, Mishawaka, IN.
Cash / Self-Pay
$6,286

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,476

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: $6,286 (662%)
Insurance Median: $1,476 (155%)
Cash: $6,286 (662% of Medicare)
Ins. Median: $1,476 (155% 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.

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
Blue Cross Blue Shield $153 - $3,474 16%
Managed Health Services - Indiana $153 16%
Mdwise $153 16%
Medicaid / KanCare $153 - $509 16%
UnitedHealthcare $153 - $984 16%
Aetna $509 - $1,525 54%
Medicare (plans) $984 - $1,004 104%
Meridian Complete $984 104%
Pace-Trinity Health $984 104%
County Coroner $1,023 108%
Provider Partners Health Plan Of Indiana $1,082 114%
Auxiant $1,476 - $2,115 155%
Physicians Health Plan Northern Indiana Health Insurance $1,476 - $2,971 155%
St Joseph County Hlth Dpt $1,476 155%
Caresource $1,525 161%
Siho Insurance Services $1,574 166%
Key Benefit Administrator $1,771 - $2,115 186%
Allied Benefit Systems $1,869 197%
Custom Design Benefits $2,115 223%
Blue Benefit Administrators Of Massachusetts $3,474 366%
Blue Care Network $3,474 366%
Blue Distinction Transplant $3,474 366%
Blue Shield - Ca $3,474 366%
Blue Shield - Id (Regence) $3,474 366%
Blue Shield - Ny Highmark Northeastern $3,474 366%
Blue Shield - Ny Highmark Western $3,474 366%
Blue Shield - Pa (Highmark) $3,474 366%
Blue Shield - Wa (Regence) $3,474 366%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 5215 Holy Cross Pkwy, Mishawaka, IN 46545
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals