CMS Price Transparency Data
Colonoscopy with biopsy
Facility: Mercy Hospital Northwest Arkansas
Billing Code: 45380 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45380
- Insurance Median: $1,061
- Cash Discount Price: $2,912
- vs. Medicare Baseline: 0.87x Medicare
The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Mercy Hospital Northwest Arkansas is $1,061. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,912. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.87x the Medicare baseline. Located in 2710 South Rife Medical Lane, Rogers, AR.
Cash / Self-Pay
$2,912
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,061
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: $2,912 (238%)
Insurance Median: $1,061 (87%)
Cash: $2,912 (238% of Medicare)
Ins. Median: $1,061 (87% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $173 - $1,355 | 14% |
| Indian Health Service Contracted [320198] | $173 | 14% |
| Indian Health Service [20198] | $173 | 14% |
| Arkansas Department Of Health [20036] | $250 | 20% |
| Medicaid / KanCare | $250 - $1,514 | 20% |
| Summit Community Care Contracted [320368] | $250 | 20% |
| Summit Community Care [20368] | $250 | 20% |
| Arkansas Total Care Contracted [320039] | $568 | 46% |
| Arkansas Total Care [20039] | $568 | 46% |
| Humana | $843 - $1,061 | 69% |
| Aetna | $1,061 | 87% |
| American Health Advantage Of Mo Mcr [20264] | $1,061 | 87% |
| Cherokee Nation Health Serv Contracted [320066] | $1,061 | 87% |
| Cigna | $1,061 | 87% |
| Cross Timbers Hospice [20098] | $1,061 | 87% |
| Dept Of Veteran Affairs Contracted [320106] | $1,061 | 87% |
| Elara Caring Aspire Hospice Contracted [320433] | $1,061 | 87% |
| Elara Caring Aspire Hospice [20433] | $1,061 | 87% |
| Globalhealth Contracted [320145] | $1,061 | 87% |
| Halo Hcr Inc Hospice Contracted [320432] | $1,061 | 87% |
| Halo Hcr Inc Hospice [20432] | $1,061 | 87% |
| Independent Health [20197] | $1,061 | 87% |
| Jordan Valley Senior Care Pace [20515] | $1,061 | 87% |
| Kindful Hospice Contracted [320434] | $1,061 | 87% |
| Kindful Hospice [20434] | $1,061 | 87% |
| Medical Associates Health [20444] | $1,061 | 87% |
| Medicare (plans) | $1,061 - $1,104 | 87% |
| Mercy Hospice Okc [20252] | $1,061 | 87% |
| Pace Of The Ozarks [20518] | $1,061 | 87% |
| Provider Partners Health Plans Contracted [320450] | $1,061 | 87% |
| Qual Choice Contracted [320325] | $1,061 | 87% |
| Spina Bifida Hlthcare Benefit [20506] | $1,061 | 87% |
| Tribute Health Plan Mcr [20338] | $1,061 | 87% |
| Tricare | $1,061 | 87% |
| UnitedHealthcare | $1,061 | 87% |
| Valir Pace [20503] | $1,061 | 87% |
| Wellfirst Health Mcr [20443] | $1,061 | 87% |
| St Johns Mercy Rehab Llc Contracted [320359] | $1,190 | 97% |
| St Johns Mercy Rehab Llc [20359] | $1,190 | 97% |
| Usable Contracted [320409] | $1,355 | 111% |
| Ambetter / Centene | $1,514 | 124% |
| Home State Health Plan Contracted [320187] | $1,514 | 124% |
| Novasys Contracted [320285] | $1,514 | 124% |
| Aither Health Contracted [320449] | $1,560 | 128% |
| Edison Health Solutions Contracted [320502] | $1,560 | 128% |
| Mercy Benefit Admin Contracted [320251] | $1,560 | 128% |
| Yuzu Health Contracted [320521] | $1,560 | 128% |
| Health Choice Contracted [320166] | $2,004 | 164% |