CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Mercy Hospital Southeast

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 45380
  • Insurance Median: $1,129
  • Cash Discount Price: $6,668
  • vs. Medicare Baseline: 0.92x Medicare
The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Mercy Hospital Southeast is $1,129. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,668. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.92x the Medicare baseline. Located in 1701 Lacey St, Cape Girardeau, MO.
Cash / Self-Pay
$6,668

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,129

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: $6,668 (545%)
Insurance Median: $1,129 (92%)
Cash: $6,668 (545% of Medicare)
Ins. Median: $1,129 (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.

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 - $6,538 15%
Indian Health Service Contracted [320198] $180 15%
Imagine 360 Contracted [320494] $745 61%
Medicaid / KanCare $1,005 82%
UnitedHealthcare $1,005 - $7,603 82%
Aetna $1,107 91%
Cross Timbers Hospice [20098] $1,107 91%
Dept Of Veteran Affairs Contracted [320106] $1,107 91%
Elara Caring Aspire Hospice Contracted [320433] $1,107 91%
Elara Caring Aspire Hospice [20433] $1,107 91%
Halo Hcr Inc Hospice Contracted [320432] $1,107 91%
Halo Hcr Inc Hospice [20432] $1,107 91%
Humana $1,107 91%
Kindful Hospice Contracted [320434] $1,107 91%
Kindful Hospice [20434] $1,107 91%
Medicare (plans) $1,107 - $1,164 91%
Mercy Hospice Okc [20252] $1,107 91%
Pace Of The Ozarks Contracted [320518] $1,107 91%
Tricare $1,107 91%
Ambetter / Centene $1,129 92%
American Health Advantage Of Mo Mcr Hmo Contracted [320264] $1,129 92%
Home State Health Plan Contracted [320187] $1,129 92%
Hope Trust Contracted [320488] $1,129 92%
Provider Partners Health Plans Contracted [320450] $1,273 104%
Consociate Consolidated Health Contracted [320490] $1,550 - $2,491 127%
Auxiant Contracted [320462] $1,862 - $2,214 152%
Centivo Contracted [320505] $1,862 152%
Ebms Contracted [320493] $1,862 152%
Healthlink Contracted [320179] $1,862 - $2,491 152%
Mercy Benefit Admin Contracted [320251] $1,862 152%
Reflect Health Contracted [320492] $1,930 158%
Preferred Health Plan Contracted [320522] $1,975 162%
United Medical Resources Contracted [320454] $7,603 622%
Cigna $14,290 1169%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1701 Lacey St, Cape Girardeau, MO 63701
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals