CMS Price Transparency Data

Colonoscopy with biopsy

Facility: St Mary's Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,252
Cash Discount Price: $1,192
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at St Mary's Medical Center is $1,252. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,192. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.02x the Medicare baseline. Located in 201 Nw R D Mize Rd, Blue Springs, MO.

Cash / Self-Pay

$1,192

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,252

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: $1,192 (98%)

Insurance Median: $1,252 (102%)

Cash: $1,192 (98% of Medicare)

Ins. Median: $1,252 (102% 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	$898 - $2,206	73%
Medicaid / KanCare	$1,005	82%
Aetna	$1,193 - $2,488	98%
Cigna	$1,193	98%
Home State	$1,193 - $1,908	98%
Medicare (plans)	$1,193 - $1,252	98%
Tricare	$1,193	98%
UnitedHealthcare	$1,193 - $3,966	98%
Veterans Evaluation Services	$1,193	98%
Kansas Superior	$1,217	100%
Healthy Blue	$1,252 - $1,437	102%
Employer Direct Healthcare	$1,670	137%
6 Degrees	$2,385	195%

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 $1,192.
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 St Mary's Medical Center 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.