CMS Price Transparency Data
Colonoscopy (diagnostic)
Facility: Mercy Hospital South
Billing Code: 45378 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45378
- Insurance Median: $850
- Cash Discount Price: $1,702
- vs. Medicare Baseline: 0.89x Medicare
The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Mercy Hospital South is $850. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,702. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.89x the Medicare baseline. Located in 10010 Kennerly Road, Saint Louis, MO.
Cash / Self-Pay
$1,702
Average discount available for prompt cash payment at this facility.
Insurance Median
$850
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: $1,702 (179%)
Insurance Median: $850 (89%)
Cash: $1,702 (179% of Medicare)
Ins. Median: $850 (89% 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 | $112 - $777 | 12% |
| Blue Cross Blue Shield | $171 - $1,806 | 18% |
| Indian Health Service Contracted [320198] | $171 | 18% |
| Aetna | $257 - $847 | 27% |
| Medica Contracted [320239] | $448 - $1,004 | 47% |
| Aither Health Contracted [320449] | $738 - $1,241 | 78% |
| Aither Health [20449] | $738 - $1,241 | 78% |
| Auxiant Contracted [320462] | $738 - $1,241 | 78% |
| Ebms Contracted [320493] | $738 - $1,241 | 78% |
| Edison Health Solutions Contracted [320502] | $738 - $1,241 | 78% |
| Healthlink Contracted [320179] | $738 - $1,241 | 78% |
| Imagine 360 Contracted [320494] | $738 - $1,241 | 78% |
| Mercy Benefit Admin Contracted [320251] | $738 - $1,241 | 78% |
| Mercy Benefit Admin [20251] | $738 - $1,241 | 78% |
| Reflect Health Contracted [320492] | $738 - $1,241 | 78% |
| Show-Me Health Administrators Contracted [320483] | $738 - $1,264 | 78% |
| Yuzu Health Contracted [320521] | $738 - $1,241 | 78% |
| Cigna | $772 - $864 | 81% |
| 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 - $1,236 | 89% |
| Kindful Hospice Contracted [320434] | $847 | 89% |
| Kindful Hospice [20434] | $847 | 89% |
| Medicare (plans) | $847 - $1,716 | 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% |
| Hope Trust Contracted [320488] | $864 - $1,201 | 91% |
| Provider Partners Health Plans Contracted [320450] | $934 | 98% |
| St Johns Mercy Rehab Llc Contracted [320359] | $934 | 98% |
| Health Choices Contracted [320448] | $1,030 | 108% |
| Health Choices [20448] | $1,030 | 108% |
| Medical Associates Health Contracted [320444] | $1,030 | 108% |
| Federal Medical Center Contracted [320127] | $1,115 | 117% |
| Insurance System Inc Contracted [320465] | $1,115 | 117% |
| Point C Contracted [320238] | $1,115 | 117% |
| Tri State Healthcare Coalition Contracted [320379] | $1,115 | 117% |
| Preferred Health Plan Contracted [320522] | $1,201 - $1,511 | 126% |
| First Health Contracted [320128] | $1,218 - $1,236 | 128% |
| Multiplan Contracted [320270] | $1,287 | 135% |
| Workers Comp [20426] | $1,287 - $1,373 | 135% |
| Centivo Contracted [320505] | $1,425 | 150% |