CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Mercy Hospital Lebanon

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,122
Cash Discount Price: $4,254
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Mercy Hospital Lebanon is $1,122. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,254. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.92x the Medicare baseline. Located in 100 Hospital Drive, Lebanon, MO.

Cash / Self-Pay

$4,254

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,122

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$1,222.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $1,222.56 (100%)

Cash / Self-Pay: $4,254 (348%)

Insurance Median: $1,122 (92%)

Cash: $4,254 (348% of Medicare)

Ins. Median: $1,122 (92% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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	$180 - $5,736	15%
Indian Health Service Contracted [320198]	$180	15%
Medicaid / KanCare	$382 - $1,005	31%
Health Systems Inc Contracted [320174]	$431	35%
Insurance System Inc Contracted [320465]	$431	35%
Point C Contracted [320238]	$760	62%
Point C [20238]	$760	62%
UnitedHealthcare	$1,005 - $1,122	82%
Medicare (plans)	$1,080 - $1,144	88%
Aetna	$1,122	92%
Champva [20065]	$1,122	92%
Cherokee Nation Health Serv Contracted [320066]	$1,122	92%
Cigna	$1,122	92%
Cross Timbers Hospice [20098]	$1,122	92%
Dept Of Veteran Affairs Contracted [320106]	$1,122	92%
Elara Caring Aspire Hospice [20433]	$1,122	92%
Globalhealth Contracted [320145]	$1,122	92%
Halo Hcr Inc Hospice Contracted [320432]	$1,122	92%
Halo Hcr Inc Hospice [20432]	$1,122	92%
Humana	$1,122	92%
Kindful Hospice Contracted [320434]	$1,122	92%
Kindful Hospice [20434]	$1,122	92%
Mercy Hospice Okc [20252]	$1,122	92%
Mercy Mgd Behavioral Health Contracted [320259]	$1,122	92%
Pace Of The Ozarks Contracted [320518]	$1,122	92%
Provider Partners Health Plans Contracted [320450]	$1,122	92%
Qual Choice Contracted [320325]	$1,122	92%
Tricare	$1,122	92%
Healthscope Contracted [320182]	$1,430	117%
Centivo Contracted [320505]	$1,887	154%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $4,254.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45380.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy Hospital Lebanon is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45380.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.