CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Missouri Baptist Sullivan Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,129
Cash Discount Price: $4,314
vs. Medicare Baseline: 2.24x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Missouri Baptist Sullivan Hospital is $2,129. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,314. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.24x the Medicare baseline. Located in 751 Sappington Bridge Rd, Sullivan, MO.

Cash / Self-Pay

$4,314

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,129

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: $4,314 (454%)

Insurance Median: $2,129 (224%)

Cash: $4,314 (454% of Medicare)

Ins. Median: $2,129 (224% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 224% of the Medicare baseline (a markup of 124%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Mercy Behavioral Health [573]	$258	27%
Aetna	$851	90%
Essence Healthcare [221]	$851	90%
Humana	$859 - $2,574	90%
UnitedHealthcare	$867 - $2,823	91%
Cox Health [757]	$894	94%
Blue Cross Blue Shield	$902 - $3,367	95%
Medica [662]	$911	96%
Devoted Health Plan [847]	$935	98%
Consociate [478]	$1,850 - $4,587	195%
Sarah Bush Lincoln [636]	$1,850 - $4,587	195%
Cox Health Systems Insurance Company [220]	$2,128	224%
Health Alliance [224]	$2,128	224%
Allied Benefits [498]	$2,245	236%
Hope Trust [806]	$2,245	236%
Cigna	$2,407 - $2,659	253%
Healthscope Benefits [258]	$2,516 - $2,823	265%
Apwu Health Plan [216]	$2,659	280%
Nalc Health Benefit Plan [242]	$2,659	280%
Priority Health [648]	$2,659	280%
Healthcare Sol Mercy [609]	$2,902	305%
Med-Pay [480]	$2,902	305%
Medica [661]	$3,096	326%
Phcs [244]	$3,096	326%

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 $4,314.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Missouri Baptist Sullivan Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45378.
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.