CMS Price Transparency Data
Colonoscopy (diagnostic)
Facility: Mercy Hospital Jefferson
Billing Code: 45378 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45378
- Insurance Median: $952
- Cash Discount Price: $2,459
- vs. Medicare Baseline: 1.00x Medicare
The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Mercy Hospital Jefferson is $952. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,459. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.00x the Medicare baseline. Located in 1400 Us Highway 61, Crystal City, MO.
Cash / Self-Pay
$2,459
Average discount available for prompt cash payment at this facility.
Insurance Median
$952
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: $2,459 (259%)
Insurance Median: $952 (100%)
Cash: $2,459 (259% of Medicare)
Ins. Median: $952 (100% 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
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Input your details and click calculate to compare out-of-pocket costs.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $159 - $777 | 17% |
| Blue Cross Blue Shield | $171 - $2,423 | 18% |
| Indian Health Service Contracted [320198] | $171 | 18% |
| Aetna | $366 - $855 | 39% |
| Medica Contracted [320239] | $637 - $1,004 | 67% |
| American Health Advantage Of Mo Mcr [10473] | $847 | 89% |
| Cherokee Nation Health Serv Contracted [320066] | $847 | 89% |
| Cross Timbers Hospice [20098] | $847 | 89% |
| Dept Of Veteran Affairs Contracted [320106] | $847 | 89% |
| Elara Caring Aspire Hospice Contracted [320433] | $847 | 89% |
| Elara Caring Aspire Hospice [20433] | $847 | 89% |
| Globalhealth Contracted [320145] | $847 | 89% |
| Halo Hcr Inc Hospice Contracted [320432] | $847 | 89% |
| Halo Hcr Inc Hospice [20432] | $847 | 89% |
| Humana | $847 | 89% |
| Kindful Hospice Contracted [320434] | $847 | 89% |
| Kindful Hospice [20434] | $847 | 89% |
| Medicare (plans) | $847 - $2,442 | 89% |
| Mercy Hospice Okc [20252] | $847 | 89% |
| Pace Of The Ozarks Contracted [320518] | $847 | 89% |
| Qual Choice Contracted [320325] | $847 | 89% |
| Tricare | $847 | 89% |
| UnitedHealthcare | $847 | 89% |
| Mercy Benefit Admin Contracted [320251] | $850 - $1,221 | 89% |
| Mercy Benefit Admin [20251] | $850 - $1,221 | 89% |
| Cigna | $864 - $1,995 | 91% |
| Hope Trust Contracted [320488] | $864 - $1,709 | 91% |
| Provider Partners Health Plans Contracted [320450] | $934 | 98% |
| Aither Health Contracted [320449] | $952 - $1,140 | 100% |
| Aither Health [20449] | $952 - $1,140 | 100% |
| Auxiant Contracted [320462] | $952 - $1,140 | 100% |
| Ebms Contracted [320493] | $952 - $1,140 | 100% |
| Edison Health Solutions Contracted [320502] | $952 - $1,140 | 100% |
| Healthlink Contracted [320179] | $952 - $1,661 | 100% |
| Imagine 360 Contracted [320494] | $952 - $1,140 | 100% |
| Reflect Health Contracted [320492] | $952 - $1,140 | 100% |
| Show-Me Health Administrators Contracted [320483] | $952 - $1,162 | 100% |
| Yuzu Health Contracted [320521] | $952 - $1,140 | 100% |
| Healthscope Contracted [320182] | $1,079 | 114% |
| Centivo Contracted [320505] | $1,425 | 150% |
| Health Choices Contracted [320448] | $1,465 | 154% |
| Health Choices [20448] | $1,465 | 154% |
| Medical Associates Health Contracted [320444] | $1,465 | 154% |
| Preferred Health Plan Contracted [320522] | $1,511 - $1,709 | 159% |
| Federal Medical Center Contracted [320127] | $1,587 | 167% |
| Insurance System Inc Contracted [320465] | $1,587 | 167% |
| Point C Contracted [320238] | $1,587 | 167% |
| Tri State Healthcare Coalition Contracted [320379] | $1,587 | 167% |
| First Health Contracted [320128] | $1,734 | 183% |
| Multiplan Contracted [320270] | $1,832 | 193% |
| Workers Comp [20426] | $1,832 - $1,954 | 193% |