CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Pulaski Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $670
Cash Discount Price: $970
vs. Medicare Baseline: 0.55x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Pulaski Memorial Hospital is $670. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $970. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.55x the Medicare baseline. Located in 616 E 13Th St, Winamac, IN.

Cash / Self-Pay

$970

Average discount available for prompt cash payment at this facility.

Insurance Median

$670

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: $970 (79%)

Insurance Median: $670 (55%)

Cash: $970 (79% of Medicare)

Ins. Median: $670 (55% 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
Ambetter / Centene	$167 - $670	14%
Blue Cross Blue Shield	$167 - $2,161	14%
Caresource Mcaid Hip	$167 - $670	14%
Caresource Mcare Hmo	$167 - $670	14%
Cenpatico Mcaid Hip	$167 - $670	14%
Humana	$167 - $1,738	14%
Mhs Mcaid Hip	$167 - $670	14%
Mhs Mcare Allwell	$167 - $677	14%
Multiplan - All Plans	$167 - $1,945	14%
UnitedHealthcare	$167 - $2,161	14%
Mhs Mcaid Hhw/Hcc	$180 - $2,161	15%
Mdwise Mcaid Hcc	$182 - $2,161	15%
Mdwise Mcaid Hhw	$182 - $2,161	15%
Mdwise Mcaid Hip - All Other Plans	$182 - $670	15%
Caresource Exch Hmo Hix - All Other Plans	$209 - $837	17%
Encore Ppo - All Other Plans	$225 - $1,837	18%
Cigna	$258 - $2,053	21%
Sagamore - All Other Plans	$258 - $1,634	21%
Sagamore Rose Acre	$258 - $1,610	21%
Caresource Mcaid Hhw	$385 - $2,161	31%
Cenpatico Mcaid Hhw - All Other Plans	$385 - $2,161	31%
Encore Workers Comp	$550 - $1,945	45%
Community Health Alliance - All Plans	$744 - $1,923	61%
Aetna	$778	64%

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 $970.
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 Pulaski Memorial Hospital 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.