CMS Price Transparency Data
Colonoscopy (diagnostic)
Facility: Mercy Hospital Lebanon
Billing Code: 45378 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45378
- Insurance Median: $1,750
- Cash Discount Price: $2,109
- vs. Medicare Baseline: 1.84x Medicare
The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Mercy Hospital Lebanon is $1,750. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,109. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.84x the Medicare baseline. Located in 100 Hospital Drive, Lebanon, MO.
Cash / Self-Pay
$2,109
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,750
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: $2,109 (222%)
Insurance Median: $1,750 (184%)
Cash: $2,109 (222% of Medicare)
Ins. Median: $1,750 (184% 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 |
|---|---|---|
| Blue Cross Blue Shield | $166 - $5,736 | 17% |
| Indian Health Service Contracted [320198] | $166 | 17% |
| Medicaid / KanCare | $547 - $777 | 58% |
| Point C Contracted [320238] | $760 - $2,079 | 80% |
| Point C [20238] | $760 - $1,750 | 80% |
| Medicare (plans) | $835 - $884 | 88% |
| Aetna | $868 - $1,641 | 91% |
| Champva [20065] | $868 | 91% |
| Cherokee Nation Health Serv Contracted [320066] | $868 | 91% |
| Cigna | $868 - $1,619 | 91% |
| Cross Timbers Hospice [20098] | $868 | 91% |
| Dept Of Veteran Affairs Contracted [320106] | $868 | 91% |
| Elara Caring Aspire Hospice [20433] | $868 | 91% |
| Globalhealth Contracted [320145] | $868 | 91% |
| Halo Hcr Inc Hospice Contracted [320432] | $868 | 91% |
| Halo Hcr Inc Hospice [20432] | $868 | 91% |
| Humana | $868 - $1,860 | 91% |
| Kindful Hospice Contracted [320434] | $868 | 91% |
| Kindful Hospice [20434] | $868 | 91% |
| Mercy Hospice Okc [20252] | $868 | 91% |
| Mercy Mgd Behavioral Health Contracted [320259] | $868 | 91% |
| Pace Of The Ozarks Contracted [320518] | $868 | 91% |
| Provider Partners Health Plans Contracted [320450] | $868 | 91% |
| Qual Choice Contracted [320325] | $868 | 91% |
| Tricare | $868 | 91% |
| UnitedHealthcare | $868 - $2,079 | 91% |
| Administrative Payor Contracted [320005] | $985 | 104% |
| Healthscope Contracted [320182] | $1,106 | 116% |
| Healthlink Contracted [320179] | $1,422 - $1,860 | 150% |
| Preferred Health Plan Contracted [320522] | $1,422 | 150% |
| Centivo Contracted [320505] | $1,459 | 154% |
| 90 Degree Benefits Contracted [320436] | $1,641 | 173% |
| Mercy Benefit Admin Contracted [320251] | $1,641 - $1,750 | 173% |
| Show-Me Health Administrators Contracted [320483] | $1,641 | 173% |
| United Medical Resources Contracted [320454] | $1,641 - $1,750 | 173% |
| Aither Health Contracted [320449] | $1,750 | 184% |
| Auxiant Contracted [320462] | $1,750 | 184% |
| Benefit Management Contracted [320052] | $1,750 | 184% |
| Ebms Contracted [320493] | $1,750 | 184% |
| Edison Health Solutions Contracted [320502] | $1,750 | 184% |
| Evolutions Health Care Contracted [320124] | $1,750 | 184% |
| First Health Contracted [320128] | $1,750 | 184% |
| Health Systems Inc Contracted [320174] | $1,750 | 184% |
| Imagine 360 Contracted [320494] | $1,750 | 184% |
| Insurance System Inc Contracted [320465] | $1,750 | 184% |
| Reflect Health Contracted [320492] | $1,750 | 184% |
| Workers Comp [20426] | $1,750 - $1,860 | 184% |
| Yuzu Health Contracted [320521] | $1,750 | 184% |
| American Healthcare Alliance Contracted [320020] | $1,860 | 196% |
| Usa Managed Care Org Contracted [320429] | $1,925 | 203% |
| Multiplan Contracted [320270] | $2,079 | 219% |
| Private Health Care Systems Contracted [320320] | $2,079 | 219% |