CMS Price Transparency Data
Colonoscopy (diagnostic)
Facility: Mercy Hospital Lincoln
Billing Code: 45378 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45378
- Insurance Median: $1,436
- Cash Discount Price: $2,312
- vs. Medicare Baseline: 1.51x Medicare
The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Mercy Hospital Lincoln is $1,436. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,312. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.51x the Medicare baseline. Located in 1000 East Cherry Street, Troy, MO.
Cash / Self-Pay
$2,312
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,436
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: $2,312 (243%)
Insurance Median: $1,436 (151%)
Cash: $2,312 (243% of Medicare)
Ins. Median: $1,436 (151% 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 | $141 - $998 | 15% |
| Aetna | $326 - $1,425 | 34% |
| Tricare | $465 | 49% |
| Medicare (plans) | $469 - $2,175 | 49% |
| UnitedHealthcare | $478 - $1,436 | 50% |
| Provider Partners Health Plans Contracted [320450] | $509 | 54% |
| American Health Advantage Of Mo Mcr [10473] | $512 | 54% |
| Blue Cross Blue Shield | $512 - $1,618 | 54% |
| Cherokee Nation Health Serv Contracted [320066] | $512 | 54% |
| Cross Timbers Hospice [20098] | $512 | 54% |
| Dept Of Veteran Affairs Contracted [320106] | $512 | 54% |
| Elara Caring Aspire Hospice Contracted [320433] | $512 | 54% |
| Elara Caring Aspire Hospice [20433] | $512 | 54% |
| Globalhealth Contracted [320145] | $512 | 54% |
| Halo Hcr Inc Hospice Contracted [320432] | $512 | 54% |
| Halo Hcr Inc Hospice [20432] | $512 | 54% |
| Humana | $512 - $1,958 | 54% |
| Indian Health Service Contracted [320198] | $512 | 54% |
| Kindful Hospice Contracted [320434] | $512 | 54% |
| Kindful Hospice [20434] | $512 | 54% |
| Mercy Hospice Okc [20252] | $512 | 54% |
| Pace Of The Ozarks Contracted [320518] | $512 | 54% |
| Qual Choice Contracted [320325] | $512 | 54% |
| Cigna | $546 - $1,805 | 57% |
| Centivo Contracted [320505] | $790 | 83% |
| Medica Contracted [320239] | $914 | 96% |
| Ambetter / Centene | $998 | 105% |
| Home State Health Plan Contracted [320187] | $998 | 105% |
| Novasys Contracted [320285] | $998 | 105% |
| Hope Trust Contracted [320488] | $1,077 | 113% |
| Health Choices Contracted [320448] | $1,305 | 137% |
| Health Choices [20448] | $1,305 | 137% |
| Medical Associates Health Contracted [320444] | $1,305 | 137% |
| First Health Contracted [320128] | $1,425 - $1,631 | 150% |
| United Medical Resources Contracted [320454] | $1,436 | 151% |
| Mercy Mgd Behavioral Health Contracted [320259] | $1,631 | 172% |
| Multiplan Contracted [320270] | $1,631 | 172% |
| Private Health Care Systems Contracted [320320] | $1,631 | 172% |
| Workers Comp [20426] | $1,631 - $1,740 | 172% |
| Healthlink Contracted [320179] | $1,762 - $1,936 | 185% |
| Aither Health Contracted [320449] | $1,849 | 195% |
| Aither Health [20449] | $1,849 | 195% |
| Auxiant Contracted [320462] | $1,849 | 195% |
| Ebms Contracted [320493] | $1,849 | 195% |
| Edison Health Solutions Contracted [320502] | $1,849 | 195% |
| Federal Medical Center Contracted [320127] | $1,849 | 195% |
| Imagine 360 Contracted [320494] | $1,849 | 195% |
| Insurance System Inc Contracted [320465] | $1,849 | 195% |
| Mercy Benefit Admin Contracted [320251] | $1,849 | 195% |
| Mercy Benefit Admin [20251] | $1,849 | 195% |
| Point C Contracted [320238] | $1,849 | 195% |
| Preferred Health Plan Contracted [320522] | $1,849 | 195% |
| Reflect Health Contracted [320492] | $1,849 | 195% |
| Show-Me Health Administrators Contracted [320483] | $1,849 | 195% |
| Tri State Healthcare Coalition Contracted [320379] | $1,849 | 195% |
| Yuzu Health Contracted [320521] | $1,849 | 195% |