Colonoscopy (diagnostic)

For the diagnostic colonoscopy procedure (CPT 45378), Mercy Hospital Columbus lists a cash median price of $1,132, which is notably lower than the facility's negotiated rates and the gross charges. While the Medicare benchmark for this service is $950.10, the facility's cash price of $1,132 exceeds the Medicare rate by 19%, reflecting a markup common in the healthcare industry where commercial rates often average 200% to 300% of the federal baseline. However, for patients with high-deductible plans or those without insurance, paying the cash price directly may be more cost-effective than relying on insurance, as many in-network payers have negotiated rates ranging from $1,265 to $1,655. Patients should verify their specific plan's deductible status before scheduling, as using insurance could result in out-of-pocket costs exceeding the cash price if the deductible has not been met.

To minimize costs, patients are encouraged to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid in full upfront. These discounts bypass the administrative overhead and claims processing fees that inflate insurance negotiated rates, offering immediate liquidity incentives to the facility. Additionally, since the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should request an itemized bill to ensure no unexpected charges are included. If a discrepancy is found, such as unbundled codes or services not rendered, a formal written audit dispute should be sent to the billing supervisor to resolve the error before payment.