CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Goshen Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $879
Cash Discount Price: $21,208
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Goshen Hospital is $879. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21,208. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.93x the Medicare baseline. Located in 200 High Park Ave, Goshen, IN.

Cash / Self-Pay

$21,208

Average discount available for prompt cash payment at this facility.

Insurance Median

$879

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: $21,208 (2232%)

Insurance Median: $879 (93%)

Cash: $21,208 (2232% of Medicare)

Ins. Median: $879 (93% 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
Advantage Health Solutions	$879	93%
Aetna	$879	93%
Atrio Health Plans	$879	93%
Bc Federal Employee	$879	93%
Bc Mcr Advantage Ppo	$879	93%
Blue Cross Blue Shield	$879	93%
Buckeye Health Plan	$879	93%
Cigna	$879	93%
Coventry Health And Life	$879	93%
Emblem Health	$879	93%
Freedom Healthcare	$879	93%
Geisinger Health Plan	$879	93%
Health First	$879	93%
Healthspring	$879	93%
Humana	$879	93%
Iehp Empire Health Plan	$879	93%
Independent Care Health Plan	$879	93%
Kaiser Permanente	$879	93%
Mcr Advantra Freedom	$879	93%
Mcr Allwell Mhs	$879	93%
Mcr Banner Health	$879	93%
Mcr Complete	$879	93%
Mcr Complete Ppo	$879	93%
Mcr Complete Wellmed	$879	93%
Mcr Health Alliance	$879	93%
Mcr Health Partners Plans	$879	93%
Mcr Medical Mutual Of Ohio	$879	93%
Mcr Passport Advantage	$879	93%
Mcr Secure Horizons Ppo	$879	93%
Mcr Texan Plus	$879	93%
Mcr Upmc For Life	$879	93%
Medicare (plans)	$879 - $932	93%
Meridian Complete	$879	93%
Optimum Healthcare	$879	93%
Paramount Elite	$879	93%
Primetime Health Plan	$879	93%
Simply Complete Hmo	$879	93%
The Umwa H&R Funds	$879	93%
Todays Options Pyramid Life	$879	93%
Trillium Advantage	$879	93%
Ucare For Seniors	$879	93%
Ucare Minnesota	$879	93%
UnitedHealthcare	$879	93%
Wellcare	$879	93%
Champva	$905	95%
Tricare	$905	95%
Mcr Devoted Health Plan	$932	98%
Mcr Provider Partners Hlth Pln	$995	105%
Ambetter / Centene	$1,267	133%
Mkt Caresource	$1,267	133%

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 $21,208.
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 Goshen Hospital 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.