Colonoscopy with biopsy
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 45380 (CPT)
- CPT Billing Code: 45380
- Insurance Median: $1,126
- Cash Discount Price: $4,674
- vs. Medicare Baseline: 0.92x 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 $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.
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 | $176 - $1,775 | 14% |
| Indian Health Service Contracted [320198] | $176 | 14% |
| Medicaid / KanCare | $382 - $1,148 | 31% |
| UnitedHealthcare | $1,005 - $1,148 | 82% |
| Halo Hcr Inc Hospice [20432] | $1,126 | 92% |
| Kindful Hospice Contracted [320434] | $1,126 | 92% |
| Cross Timbers Hospice [20098] | $1,126 | 92% |
| Elara Caring Aspire Hospice [20433] | $1,126 | 92% |
| Humana | $1,126 | 92% |
| Dept Of Veteran Affairs Contracted [320106] | $1,126 | 92% |
| Tricare | $1,126 | 92% |
| Pace Of The Ozarks Contracted [320518] | $1,126 | 92% |
| Medicare (plans) | $1,126 - $1,172 | 92% |
| Halo Hcr Inc Hospice Contracted [320432] | $1,126 | 92% |
| Kindful Hospice [20434] | $1,126 | 92% |
| Mercy Hospice Okc [20252] | $1,126 | 92% |
| Aetna | $1,126 | 92% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $1,126 | 92% |
| Ambetter / Centene | $1,148 | 94% |
| Home State Health Plan Contracted [320187] | $1,148 | 94% |
| Providrs Care Network Contracted [320484] | $2,181 | 178% |
| Health Choice Contracted [320166] | $2,358 | 193% |
Consumer Guidance & Cost Commentary
For a colonoscopy with biopsy at Mercy Hospital Pittsburg, Inc., the cash price is $4,674, which is significantly higher than the state average of $1,771. While commercial insurance plans typically negotiate rates around $1,126, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket and asking for a prompt-pay discount before scheduling. It is important to note that while the facility is in-network for many payers, the negotiated rates do not always represent the lowest possible cost, and patients should verify their specific plan's allowed amount to avoid unexpected balances.
The facility's gross charge of $7,191 serves as the baseline, but the actual cost to patients varies widely depending on their insurance status and payment timing. Under the No Surprises Act, patients are protected from balance billing for out-of-network providers at in-network facilities, though they should still request an itemized bill to ensure no unbundled codes or services not rendered are included. If you choose to pay cash, you can often reduce the $4,674 cash median by discussing self-pay or prompt-pay discounts directly with the hospital, as these upfront payments bypass the administrative costs and claim processing fees that inflate insurance rates.