CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Pulaski Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $601
Cash Discount Price: $920
vs. Medicare Baseline: 0.63x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Pulaski Memorial Hospital is $601. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $920. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.63x the Medicare baseline. Located in 616 E 13Th St, Winamac, IN.

Cash / Self-Pay

$920

Average discount available for prompt cash payment at this facility.

Insurance Median

$601

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: $920 (97%)

Insurance Median: $601 (63%)

Cash: $920 (97% of Medicare)

Ins. Median: $601 (63% 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
Ambetter / Centene	$154 - $626	16%
Blue Cross Blue Shield	$154 - $2,019	16%
Caresource Mcaid Hip	$154 - $626	16%
Caresource Mcare Hmo	$154 - $626	16%
Cenpatico Mcaid Hip	$154 - $626	16%
Humana	$154 - $1,624	16%
Mhs Mcaid Hip	$154 - $626	16%
Mhs Mcare Allwell	$154 - $632	16%
Multiplan - All Plans	$154 - $1,817	16%
UnitedHealthcare	$154 - $2,019	16%
Caresource Mcaid Hhw	$166 - $2,019	17%
Cenpatico Mcaid Hhw - All Other Plans	$166 - $2,019	17%
Mhs Mcaid Hhw/Hcc	$166 - $2,019	17%
Mdwise Mcaid Hcc	$167 - $2,019	18%
Mdwise Mcaid Hhw	$167 - $2,019	18%
Mdwise Mcaid Hip - All Other Plans	$167 - $626	18%
Caresource Exch Hmo Hix - All Other Plans	$193 - $782	20%
Encore Ppo - All Other Plans	$208 - $1,716	22%
Cigna	$235 - $1,918	25%
Sagamore - All Other Plans	$235 - $1,527	25%
Sagamore Rose Acre	$235 - $1,504	25%
Encore Workers Comp	$547 - $1,817	58%
Community Health Alliance - All Plans	$576 - $1,797	61%
Aetna	$727	77%

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 $920.
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 Pulaski Memorial 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.