CMS Price Transparency Data
Colonoscopy (diagnostic)
Facility: Mercy St Francis Hospital
Billing Code: 45378 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45378
- Insurance Median: $630
- Cash Discount Price: $2,357
- vs. Medicare Baseline: 0.66x Medicare
The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Mercy St Francis Hospital is $630. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,357. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.66x the Medicare baseline. Located in 100 West Highway 60, Po Box 82, Mountain View, MO.
Cash / Self-Pay
$2,357
Average discount available for prompt cash payment at this facility.
Insurance Median
$630
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: $2,357 (248%)
Insurance Median: $630 (66%)
Cash: $2,357 (248% of Medicare)
Ins. Median: $630 (66% 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 |
|---|---|---|
| Centivo Contracted [320505] | $187 | 20% |
| Medicare (plans) | $211 - $960 | 22% |
| Point C Contracted [320238] | $220 - $1,329 | 23% |
| Humana | $238 - $1,259 | 25% |
| Pace of the Ozarks Contracted [320518] | $238 | 25% |
| Provider Partners Health Plans Contracted [320450] | $238 | 25% |
| Blue Cross Blue Shield | $238 - $1,259 | 25% |
| Cigna | $238 - $321 | 25% |
| Globalhealth Contracted [320145] | $238 | 25% |
| Medical Associates Health Contracted [320444] | $238 | 25% |
| Qual Choice Contracted [320325] | $238 | 25% |
| Healthlink Contracted [320179] | $246 - $1,329 | 26% |
| Medicaid / KanCare | $261 - $777 | 27% |
| Home State Health Plan Contracted [320187] | $261 | 27% |
| Ambetter / Centene | $261 | 27% |
| Novasys Contracted [320285] | $261 | 27% |
| Aetna | $287 - $480 | 30% |
| UnitedHealthcare | $349 - $1,329 | 37% |
| Indian Health Service Contracted [320198] | $385 - $480 | 41% |
| Mercy Hospice Okc [20252] | $385 - $480 | 41% |
| Cherokee Nation Health Serv Contracted [320066] | $385 - $480 | 41% |
| Elara Caring Aspire Hospice [20433] | $385 - $480 | 41% |
| Acentra Health Contracted [320527] | $385 | 41% |
| Halo Hcr Inc Hospice Contracted [320432] | $385 - $480 | 41% |
| Mercy Mgd Behavioral Health Contracted [320259] | $385 - $480 | 41% |
| Dept of Veteran Affairs Contracted [320106] | $385 - $480 | 41% |
| Cross Timbers Hospice [20098] | $385 - $480 | 41% |
| Halo Hcr Inc Hospice [20432] | $385 - $480 | 41% |
| Kindful Hospice [20434] | $385 - $480 | 41% |
| Kindful Hospice Contracted [320434] | $385 - $480 | 41% |
| United Medical Resources Contracted [320454] | $407 - $1,259 | 43% |
| Tricare | $476 | 50% |
| Healthscope Contracted [320182] | $480 - $638 | 51% |
| Private Health Care Systems Contracted [320320] | $604 - $1,000 | 64% |
| Multiplan Contracted [320270] | $604 - $1,000 | 64% |
| Administrative Payor Contracted [320005] | $630 | 66% |
| Preferred Health Plan Contracted [320522] | $909 | 96% |
| Workers Comp [20426] | $1,119 - $1,189 | 118% |
| Mercy Benefit Admin Contracted [320251] | $1,259 - $1,329 | 133% |
| Auxiant Contracted [320462] | $1,259 - $1,329 | 133% |
| Imagine 360 Contracted [320494] | $1,329 | 140% |
| Benefit Management Contracted [320052] | $1,329 | 140% |
| Aither Health Contracted [320449] | $1,329 | 140% |
| Evolutions Health Care Contracted [320124] | $1,329 | 140% |
| Point C [20238] | $1,329 | 140% |
| Show-Me Health Administrators Contracted [320483] | $1,329 | 140% |
| Ebms Contracted [320493] | $1,329 | 140% |
| Edison Health Solutions Contracted [320502] | $1,329 | 140% |
| First Health Contracted [320128] | $1,329 | 140% |
| Yuzu Health Contracted [320521] | $1,329 | 140% |
| USA Managed Care Org Contracted [320429] | $1,329 | 140% |
| Insurance System Inc Contracted [320465] | $1,329 | 140% |
| Health Systems Inc Contracted [320174] | $1,329 | 140% |
| Reflect Health Contracted [320492] | $1,329 | 140% |