CMS Price Transparency Data
Colonoscopy with biopsy
Facility: Mercy St Francis Hospital
Billing Code: 45380 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45380
- Insurance Median: $750
- Cash Discount Price: $2,665
- vs. Medicare Baseline: 0.61x Medicare
The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Mercy St Francis Hospital is $750. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,665. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.61x the Medicare baseline. Located in 100 West Highway 60, Po Box 82, Mountain View, MO.
Cash / Self-Pay
$2,665
Average discount available for prompt cash payment at this facility.
Insurance Median
$750
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: $2,665 (218%)
Insurance Median: $750 (61%)
Cash: $2,665 (218% of Medicare)
Ins. Median: $750 (61% 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.
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] | $202 | 17% |
| Medicare (plans) | $229 - $1,236 | 19% |
| Point C Contracted [320238] | $240 - $1,584 | 20% |
| Healthlink Contracted [320179] | $268 - $1,584 | 22% |
| Home State Health Plan Contracted [320187] | $283 | 23% |
| Ambetter / Centene | $283 | 23% |
| Medicaid / KanCare | $283 - $1,005 | 23% |
| Novasys Contracted [320285] | $283 | 23% |
| Pace of the Ozarks Contracted [320518] | $285 | 23% |
| Humana | $285 - $1,500 | 23% |
| Globalhealth Contracted [320145] | $285 | 23% |
| Blue Cross Blue Shield | $285 - $1,509 | 23% |
| Provider Partners Health Plans Contracted [320450] | $285 | 23% |
| Cigna | $285 - $383 | 23% |
| Medical Associates Health Contracted [320444] | $285 | 23% |
| Qual Choice Contracted [320325] | $285 | 23% |
| Aetna | $311 - $572 | 25% |
| United Medical Resources Contracted [320454] | $441 - $1,500 | 36% |
| UnitedHealthcare | $441 - $1,584 | 36% |
| Mercy Mgd Behavioral Health Contracted [320259] | $458 - $572 | 37% |
| Kindful Hospice [20434] | $458 - $572 | 37% |
| Cross Timbers Hospice [20098] | $458 - $572 | 37% |
| Mercy Hospice Okc [20252] | $458 - $572 | 37% |
| Indian Health Service Contracted [320198] | $458 - $572 | 37% |
| Acentra Health Contracted [320527] | $458 | 37% |
| Dept of Veteran Affairs Contracted [320106] | $458 - $572 | 37% |
| Halo Hcr Inc Hospice Contracted [320432] | $458 - $572 | 37% |
| Kindful Hospice Contracted [320434] | $458 - $572 | 37% |
| Elara Caring Aspire Hospice [20433] | $458 - $572 | 37% |
| Cherokee Nation Health Serv Contracted [320066] | $458 - $572 | 37% |
| Halo Hcr Inc Hospice [20432] | $458 - $572 | 37% |
| Tricare | $567 | 46% |
| Healthscope Contracted [320182] | $572 - $760 | 47% |
| Private Health Care Systems Contracted [320320] | $715 - $1,000 | 58% |
| Multiplan Contracted [320270] | $715 - $1,000 | 58% |
| Administrative Payor Contracted [320005] | $750 | 61% |
| Preferred Health Plan Contracted [320522] | $1,084 | 89% |
| Workers Comp [20426] | $1,334 - $1,417 | 109% |
| Auxiant Contracted [320462] | $1,500 - $1,584 | 123% |
| Mercy Benefit Admin Contracted [320251] | $1,500 - $1,584 | 123% |
| Benefit Management Contracted [320052] | $1,584 | 130% |
| Imagine 360 Contracted [320494] | $1,584 | 130% |
| Yuzu Health Contracted [320521] | $1,584 | 130% |
| Ebms Contracted [320493] | $1,584 | 130% |
| Evolutions Health Care Contracted [320124] | $1,584 | 130% |
| USA Managed Care Org Contracted [320429] | $1,584 | 130% |
| First Health Contracted [320128] | $1,584 | 130% |
| Point C [20238] | $1,584 | 130% |
| Aither Health Contracted [320449] | $1,584 | 130% |
| Show-Me Health Administrators Contracted [320483] | $1,584 | 130% |
| Insurance System Inc Contracted [320465] | $1,584 | 130% |
| Reflect Health Contracted [320492] | $1,584 | 130% |
| Health Systems Inc Contracted [320174] | $1,584 | 130% |
| Edison Health Solutions Contracted [320502] | $1,584 | 130% |