CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Saint Joseph Regional Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,899
Cash Discount Price: $6,788
vs. Medicare Baseline: 1.55x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Saint Joseph Regional Medical Center is $1,899. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,788. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.55x the Medicare baseline. Located in 5215 Holy Cross Pkwy, Mishawaka, IN.

Cash / Self-Pay

$6,788

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,899

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: $6,788 (555%)

Insurance Median: $1,899 (155%)

Cash: $6,788 (555% of Medicare)

Ins. Median: $1,899 (155% 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.

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
Blue Cross Blue Shield	$153 - $4,470	13%
Managed Health Services - Indiana	$153	13%
Mdwise	$153	13%
Medicaid / KanCare	$153 - $655	13%
UnitedHealthcare	$153 - $1,266	13%
Aetna	$655 - $1,962	54%
Medicare (plans)	$1,266 - $1,291	104%
Meridian Complete	$1,266	104%
Pace-Trinity Health	$1,266	104%
County Coroner	$1,317	108%
Provider Partners Health Plan Of Indiana	$1,393	114%
Auxiant	$1,899 - $2,722	155%
Physicians Health Plan Northern Indiana Health Insurance	$1,899 - $3,824	155%
St Joseph County Hlth Dpt	$1,899	155%
Caresource	$1,962	160%
Siho Insurance Services	$2,026	166%
Key Benefit Administrator	$2,279 - $2,722	186%
Allied Benefit Systems	$2,406	197%
Custom Design Benefits	$2,722	223%
Blue Benefit Administrators Of Massachusetts	$4,470	366%
Blue Care Network	$4,470	366%
Blue Distinction Transplant	$4,470	366%
Blue Shield - Ca	$4,470	366%
Blue Shield - Id (Regence)	$4,470	366%
Blue Shield - Ny Highmark Northeastern	$4,470	366%
Blue Shield - Ny Highmark Western	$4,470	366%
Blue Shield - Pa (Highmark)	$4,470	366%
Blue Shield - Wa (Regence)	$4,470	366%

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 $6,788.
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 Saint Joseph Regional Medical Center 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.