CMS Price Transparency Data
Colonoscopy (diagnostic)
Facility: Mercy Hospital Southeast
Billing Code: 45378 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45378
- Insurance Median: $1,620
- Cash Discount Price: $3,930
- vs. Medicare Baseline: 1.71x Medicare
The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Mercy Hospital Southeast is $1,620. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,930. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.71x the Medicare baseline. Located in 1701 Lacey St, Cape Girardeau, MO.
Cash / Self-Pay
$3,930
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,620
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: $3,930 (414%)
Insurance Median: $1,620 (171%)
Cash: $3,930 (414% of Medicare)
Ins. Median: $1,620 (171% 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 - $5,056 | 17% |
| Indian Health Service Contracted [320198] | $166 | 17% |
| Aetna | $244 - $2,037 | 26% |
| Medicaid / KanCare | $244 - $777 | 26% |
| Imagine 360 Contracted [320494] | $576 - $2,631 | 61% |
| UnitedHealthcare | $777 - $5,879 | 82% |
| Cross Timbers Hospice [20098] | $856 | 90% |
| Dept Of Veteran Affairs Contracted [320106] | $856 - $3,759 | 90% |
| Elara Caring Aspire Hospice Contracted [320433] | $856 | 90% |
| Elara Caring Aspire Hospice [20433] | $856 | 90% |
| Halo Hcr Inc Hospice Contracted [320432] | $856 | 90% |
| Halo Hcr Inc Hospice [20432] | $856 | 90% |
| Humana | $856 - $3,195 | 90% |
| Kindful Hospice Contracted [320434] | $856 | 90% |
| Kindful Hospice [20434] | $856 | 90% |
| Medicare (plans) | $856 - $2,443 | 90% |
| Mercy Hospice Okc [20252] | $856 | 90% |
| Pace Of The Ozarks Contracted [320518] | $856 | 90% |
| Tricare | $856 | 90% |
| Ambetter / Centene | $873 | 92% |
| American Health Advantage Of Mo Mcr Hmo Contracted [320264] | $873 | 92% |
| Home State Health Plan Contracted [320187] | $873 | 92% |
| Hope Trust Contracted [320488] | $873 - $2,631 | 92% |
| Provider Partners Health Plans Contracted [320450] | $985 | 104% |
| Consociate Consolidated Health Contracted [320490] | $1,199 - $1,926 | 126% |
| Auxiant Contracted [320462] | $1,440 - $2,631 | 152% |
| Centivo Contracted [320505] | $1,440 | 152% |
| Ebms Contracted [320493] | $1,440 - $2,631 | 152% |
| Healthlink Contracted [320179] | $1,440 - $2,631 | 152% |
| Mercy Benefit Admin Contracted [320251] | $1,440 - $2,631 | 152% |
| Reflect Health Contracted [320492] | $1,492 - $2,631 | 157% |
| Preferred Health Plan Contracted [320522] | $1,527 - $2,631 | 161% |
| First Health Contracted [320128] | $2,037 | 214% |
| Health Alliance Contracted [320164] | $2,443 | 257% |
| Aither Health Contracted [320449] | $2,556 | 269% |
| Edison Health Solutions Contracted [320502] | $2,556 | 269% |
| Mercy Benefit Admin [20251] | $2,556 | 269% |
| Yuzu Health Contracted [320521] | $2,556 | 269% |
| Workers Comp [20426] | $2,819 - $3,007 | 297% |
| Multiplan Contracted [320270] | $3,007 | 316% |
| Private Health Care Systems Contracted [320320] | $3,007 | 316% |
| United Medical Resources Contracted [320454] | $5,879 | 619% |
| Cigna | $14,290 | 1504% |