Colonoscopy (diagnostic)
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 45378 (CPT)
- CPT Billing Code: 45378
- Insurance Median: $1,135
- Cash Discount Price: $3,630
- vs. Medicare Baseline: 1.19x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $162 - $3,857 | 17% |
| Indian Health Service Contracted [320198] | $162 | 17% |
| Medicaid / KanCare | $296 - $1,134 | 31% |
| Health Choice Contracted [320166] | $454 - $1,823 | 48% |
| UnitedHealthcare | $777 - $3,059 | 82% |
| Humana | $871 | 92% |
| Halo Hcr Inc Hospice Contracted [320432] | $871 | 92% |
| Tricare | $871 | 92% |
| Pace Of The Ozarks Contracted [320518] | $871 | 92% |
| Elara Caring Aspire Hospice [20433] | $871 | 92% |
| Mercy Hospice Okc [20252] | $871 | 92% |
| Medicare (plans) | $871 - $906 | 92% |
| Aetna | $871 - $3,857 | 92% |
| Dept Of Veteran Affairs Contracted [320106] | $871 | 92% |
| Halo Hcr Inc Hospice [20432] | $871 | 92% |
| Kindful Hospice [20434] | $871 | 92% |
| Cross Timbers Hospice [20098] | $871 | 92% |
| Kindful Hospice Contracted [320434] | $871 | 92% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $871 | 92% |
| Ambetter / Centene | $888 | 93% |
| Home State Health Plan Contracted [320187] | $888 | 93% |
| Medica Contracted [320239] | $1,652 | 174% |
| Providrs Care Network Contracted [320484] | $1,686 - $2,723 | 177% |
| United Medical Resources Contracted [320454] | $3,059 | 322% |
| Cigna | $3,131 - $3,494 | 330% |
| Edison Health Solutions Contracted [320502] | $3,630 | 382% |
| Imagine 360 Contracted [320494] | $3,630 | 382% |
| Mercy Benefit Admin Contracted [320251] | $3,630 | 382% |
| American Healthcare Alliance Contracted [320020] | $3,630 | 382% |
| Workers Comp [20426] | $3,630 | 382% |
| Aither Health Contracted [320449] | $3,630 | 382% |
| Reflect Health Contracted [320492] | $3,630 | 382% |
| Healthlink Contracted [320179] | $3,630 | 382% |
| Ebms Contracted [320493] | $3,630 | 382% |
| Yuzu Health Contracted [320521] | $3,630 | 382% |
| Auxiant Contracted [320462] | $3,630 | 382% |
| First Health Contracted [320128] | $3,857 | 406% |
Consumer Guidance & Cost Commentary
For the diagnostic colonoscopy procedure at Mercy Hospital Pittsburg, Inc., the cash price is $3,630, which matches the state of Kansas average for this service. While many commercial insurance plans negotiate rates significantly higher than the cash price—ranging from $871 to $3,857 depending on the carrier—patients with high-deductible plans may find paying the cash rate directly more affordable. The facility offers a prompt-pay discount for upfront payment, which can reduce the final cost, and patients should explicitly request self-pay pricing or a prompt-pay waiver before scheduling to avoid automatic insurance billing that could result in higher charges.
The data indicates that while the cash rate aligns with state averages, the negotiated rates paid by various payers vary widely, with some plans paying as high as $3,857. It is important to note that the median negotiated amount across all payers is $1,135, and the median amount actually paid by patients is $894, suggesting that many patients receive substantial discounts through their insurance. However, because the cash price is already at the state average, patients should verify their specific plan's allowed amount and deductible status before proceeding, as assuming that in-network coverage guarantees the lowest possible price can lead to unexpected costs if the plan's negotiated rate exceeds the cash price.