CMS Price Transparency Data
Colonoscopy (diagnostic)
Facility: Mercy Hospital Joplin
Billing Code: 45378 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45378
- Insurance Median: $864
- Cash Discount Price: $1,845
- vs. Medicare Baseline: 0.91x Medicare
The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Mercy Hospital Joplin is $864. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,845. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.91x the Medicare baseline. Located in 100 Mercy Way, Joplin, MO.
Cash / Self-Pay
$1,845
Average discount available for prompt cash payment at this facility.
Insurance Median
$864
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: $1,845 (194%)
Insurance Median: $864 (91%)
Cash: $1,845 (194% of Medicare)
Ins. Median: $864 (91% 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 | $166 - $1,540 | 17% |
| Indian Health Service Contracted [320198] | $166 - $1,097 | 17% |
| Health Choice Contracted [320166] | $169 - $1,368 | 18% |
| Benefit Management Contracted [320052] | $414 - $726 | 44% |
| Medicaid / KanCare | $422 - $812 | 44% |
| Humana | $506 - $787 | 53% |
| Point C Contracted [320238] | $591 - $1,350 | 62% |
| Medica Contracted [320239] | $614 | 65% |
| United Medical Resources Contracted [320454] | $675 - $2,307 | 71% |
| UnitedHealthcare | $675 - $812 | 71% |
| Health Systems Inc Contracted [320174] | $726 | 76% |
| Insurance System Inc Contracted [320465] | $726 | 76% |
| 90 Degree Benefits Contracted [320436] | $754 - $1,013 | 79% |
| Mercy Benefit Admin Contracted [320251] | $754 - $1,013 | 79% |
| Show-Me Health Administrators Contracted [320483] | $754 - $1,013 | 79% |
| Administrative Payor Contracted [320005] | $760 | 80% |
| Aetna | $812 - $1,047 | 85% |
| Champva [20065] | $812 | 85% |
| Cherokee Nation Health Serv Contracted [320066] | $812 | 85% |
| Cigna | $812 - $1,300 | 85% |
| Cross Timbers Hospice [20098] | $812 | 85% |
| Dept Of Veteran Affairs Contracted [320106] | $812 | 85% |
| Elara Caring Aspire Hospice [20433] | $812 | 85% |
| Globalhealth Contracted [320145] | $812 | 85% |
| Halo Hcr Inc Hospice Contracted [320432] | $812 | 85% |
| Halo Hcr Inc Hospice [20432] | $812 | 85% |
| Kindful Hospice Contracted [320434] | $812 | 85% |
| Kindful Hospice [20434] | $812 | 85% |
| Medicare (plans) | $812 - $853 | 85% |
| Mercy Hospice Okc [20252] | $812 | 85% |
| Mercy Mgd Behavioral Health Contracted [320259] | $812 | 85% |
| Pace Of The Ozarks Contracted [320518] | $812 | 85% |
| Provider Partners Health Plans Contracted [320450] | $812 | 85% |
| Qual Choice Contracted [320325] | $812 | 85% |
| Tricare | $812 | 85% |
| Centivo Contracted [320505] | $828 | 87% |
| Aither Health Contracted [320449] | $864 - $962 | 91% |
| Auxiant Contracted [320462] | $864 - $1,097 | 91% |
| Ebms Contracted [320493] | $864 - $962 | 91% |
| Edison Health Solutions Contracted [320502] | $864 - $962 | 91% |
| Healthlink Contracted [320179] | $864 - $1,097 | 91% |
| Imagine 360 Contracted [320494] | $864 - $962 | 91% |
| Reflect Health Contracted [320492] | $864 - $962 | 91% |
| Yuzu Health Contracted [320521] | $864 - $962 | 91% |
| Providrs Care Network Contracted [320484] | $1,013 - $1,686 | 107% |
| Healthscope Contracted [320182] | $1,035 | 109% |
| Preferred Health Plan Contracted [320522] | $1,097 | 115% |
| First Health Contracted [320128] | $1,150 | 121% |
| American Healthcare Alliance Contracted [320020] | $1,182 | 124% |
| Multiplan Contracted [320270] | $1,300 - $1,671 | 137% |
| Private Health Care Systems Contracted [320320] | $1,300 - $1,671 | 137% |
| Usable Contracted [320409] | $1,300 - $1,671 | 137% |
| Point C [20238] | $1,350 | 142% |
| Workers Comp [20426] | $1,350 - $1,688 | 142% |
| Usa Managed Care Org Contracted [320429] | $1,485 | 156% |
| Ppo Plus Contracted [320310] | $1,519 | 160% |