CMS Price Transparency Data
Colonoscopy (diagnostic)
Facility: Mercy Hospital Fort Smith
Billing Code: 45378 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45378
- Insurance Median: $834
- Cash Discount Price: $1,648
- vs. Medicare Baseline: 0.88x Medicare
The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Mercy Hospital Fort Smith is $834. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,648. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.88x the Medicare baseline. Located in 7301 Rogers Ave, Fort Smith, AR.
Cash / Self-Pay
$1,648
Average discount available for prompt cash payment at this facility.
Insurance Median
$834
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: $1,648 (173%)
Insurance Median: $834 (88%)
Cash: $1,648 (173% of Medicare)
Ins. Median: $834 (88% 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
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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 | $160 - $1,048 | 17% |
| Indian Health Service Contracted [320198] | $160 | 17% |
| Indian Health Service [20198] | $160 | 17% |
| Mercy Interfacility [20513] | $391 | 41% |
| Aetna | $444 - $1,421 | 47% |
| Aither Health Contracted [320449] | $444 - $1,153 | 47% |
| Edison Health Solutions Contracted [320502] | $444 - $1,153 | 47% |
| Humana | $444 - $1,421 | 47% |
| Medicaid / KanCare | $444 - $1,190 | 47% |
| Mercy Benefit Admin Contracted [320251] | $444 - $1,153 | 47% |
| Ambetter / Centene | $686 - $1,190 | 72% |
| Home State Health Plan Contracted [320187] | $686 - $1,190 | 72% |
| Novasys Contracted [320285] | $686 - $1,243 | 72% |
| American Health Advantage Of Mo Mcr [20264] | $834 | 88% |
| Cherokee Nation Health Serv Contracted [320066] | $834 | 88% |
| Cross Timbers Hospice [20098] | $834 | 88% |
| Dept Of Veteran Affairs Contracted [320106] | $834 | 88% |
| Elara Caring Aspire Hospice Contracted [320433] | $834 | 88% |
| Elara Caring Aspire Hospice [20433] | $834 | 88% |
| Globalhealth Contracted [320145] | $834 | 88% |
| Halo Hcr Inc Hospice Contracted [320432] | $834 | 88% |
| Halo Hcr Inc Hospice [20432] | $834 | 88% |
| Independent Health [20197] | $834 | 88% |
| Jordan Valley Senior Care Pace [20515] | $834 | 88% |
| Kindful Hospice Contracted [320434] | $834 | 88% |
| Kindful Hospice [20434] | $834 | 88% |
| Medical Associates Health [20444] | $834 | 88% |
| Medicare (plans) | $834 - $876 | 88% |
| Mercy Hospice Okc [20252] | $834 | 88% |
| Pace Of The Ozarks [20518] | $834 | 88% |
| Provider Partners Health Plans Contracted [320450] | $834 | 88% |
| Qual Choice Contracted [320325] | $834 | 88% |
| Spina Bifida Hlthcare Benefit [20506] | $834 | 88% |
| Tribute Health Plan Mcr [20338] | $834 | 88% |
| Tricare | $834 | 88% |
| UnitedHealthcare | $834 - $1,066 | 88% |
| Valir Pace [20503] | $834 | 88% |
| Wellfirst Health Mcr [20443] | $834 | 88% |
| Cigna | $876 - $1,012 | 92% |
| 90 Degree Benefits Contracted [320436] | $888 | 93% |
| Show-Me Health Administrators Contracted [320483] | $888 | 93% |
| Usable Contracted [320409] | $1,040 - $1,048 | 109% |
| Auxiant Contracted [320462] | $1,066 - $1,154 | 112% |
| Ebms Contracted [320493] | $1,066 | 112% |
| Health Choice Contracted [320166] | $1,066 - $1,368 | 112% |
| Healthlink Contracted [320179] | $1,066 - $1,154 | 112% |
| Imagine 360 Contracted [320494] | $1,066 | 112% |
| Municipal Health Plan Contracted [320271] | $1,066 | 112% |
| Qual Choice Contracted [320324] | $1,066 | 112% |
| Reflect Health Contracted [320492] | $1,066 | 112% |
| United Medical Resources Contracted [320454] | $1,066 | 112% |
| Insurance System Inc Contracted [320465] | $1,154 | 121% |
| Personify Health Contracted [320051] | $1,154 | 121% |
| Preferred Health Plan Contracted [320522] | $1,154 | 121% |
| Workers Comp [20426] | $1,154 | 121% |
| Ppo Plus Contracted [320310] | $1,332 | 140% |
| Private Health Care Systems Contracted [320320] | $1,421 | 150% |
| Private Health Care Systems [20320] | $1,421 | 150% |
| Multiplan Contracted [320270] | $1,510 | 159% |
| Multiplan [20270] | $1,510 | 159% |