CMS Price Transparency Data
Colonoscopy with biopsy
Facility: Mercy Hospital Springfield
Billing Code: 45380 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45380
- Insurance Median: $1,005
- Cash Discount Price: $3,461
- vs. Medicare Baseline: 0.82x Medicare
The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Mercy Hospital Springfield is $1,005. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,461. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.82x the Medicare baseline. Located in 2115 S. Fremont Ave, Springfield, MO.
Cash / Self-Pay
$3,461
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,005
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: $3,461 (283%)
Insurance Median: $1,005 (82%)
Cash: $3,461 (283% of Medicare)
Ins. Median: $1,005 (82% 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.
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 - $2,660 | 15% |
| Medicaid / KanCare | $250 - $1,005 | 20% |
| Evolutions Health Care Contracted [320124] | $431 | 35% |
| Federal Medical Center Contracted [320127] | $467 | 38% |
| Benefit Management Contracted [320052] | $483 | 40% |
| Health Systems Inc Contracted [320174] | $483 | 40% |
| Insurance System Inc Contracted [320465] | $483 | 40% |
| Mercy Benefit Admin Contracted [320251] | $824 - $953 | 67% |
| Point C Contracted [320238] | $846 - $1,240 | 69% |
| Point C [20238] | $858 | 70% |
| 90 Degree Benefits Contracted [320436] | $909 | 74% |
| Aither Health Contracted [320449] | $909 | 74% |
| Auxiant Contracted [320462] | $909 | 74% |
| Ebms Contracted [320493] | $909 | 74% |
| Edison Health Solutions Contracted [320502] | $909 | 74% |
| Healthlink Contracted [320179] | $909 | 74% |
| Imagine 360 Contracted [320494] | $909 | 74% |
| Reflect Health Contracted [320492] | $909 | 74% |
| Show-Me Health Administrators Contracted [320483] | $909 - $952 | 74% |
| Yuzu Health Contracted [320521] | $909 | 74% |
| UnitedHealthcare | $1,005 - $1,671 | 82% |
| Aetna | $1,048 | 86% |
| Centurion Of Missouri [20459] | $1,048 | 86% |
| Champva [20065] | $1,048 | 86% |
| Cherokee Nation Health Serv Contracted [320066] | $1,048 | 86% |
| Cigna | $1,048 | 86% |
| Cross Timbers Hospice [20098] | $1,048 | 86% |
| Dept Of Veteran Affairs Contracted [320106] | $1,048 | 86% |
| Elara Caring Aspire Hospice [20433] | $1,048 | 86% |
| Globalhealth Contracted [320145] | $1,048 | 86% |
| Halo Hcr Inc Hospice Contracted [320432] | $1,048 | 86% |
| Halo Hcr Inc Hospice [20432] | $1,048 | 86% |
| Humana | $1,048 - $1,294 | 86% |
| Indian Health Service Contracted [320198] | $1,048 | 86% |
| Indian Health Service [20198] | $1,048 | 86% |
| Kindful Hospice Contracted [320434] | $1,048 | 86% |
| Kindful Hospice [20434] | $1,048 | 86% |
| Medicare (plans) | $1,048 - $1,101 | 86% |
| Mercy Hospice Okc [20252] | $1,048 | 86% |
| Mercy Mgd Behavioral Health Contracted [320259] | $1,048 | 86% |
| Mercy Rehab Hospital Contracted [320260] | $1,048 | 86% |
| Pace Of The Ozarks Contracted [320518] | $1,048 | 86% |
| Qual Choice Contracted [320325] | $1,048 | 86% |
| Tricare | $1,048 | 86% |
| Provider Partners Health Plans Contracted [320450] | $1,154 | 94% |
| Healthscope Contracted [320182] | $1,335 | 109% |
| Multiplan Contracted [320270] | $1,671 | 137% |
| Private Health Care Systems Contracted [320320] | $1,671 | 137% |
| Centivo Contracted [320505] | $1,762 | 144% |
| Providrs Care Network Contracted [320484] | $2,181 | 178% |
| United Medical Resources Contracted [320454] | $2,307 | 189% |