CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Missouri Baptist Sullivan Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,607
Cash Discount Price: $8,138
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Missouri Baptist Sullivan Hospital is $1,607. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,138. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.31x the Medicare baseline. Located in 751 Sappington Bridge Rd, Sullivan, MO.

Cash / Self-Pay

$8,138

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,607

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: $8,138 (666%)

Insurance Median: $1,607 (131%)

Cash: $8,138 (666% of Medicare)

Ins. Median: $1,607 (131% 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
Aetna	$463 - $926	38%
Essence Healthcare [221]	$463 - $926	38%
Humana	$467 - $2,799	38%
UnitedHealthcare	$472 - $2,823	39%
Cox Health [757]	$486 - $972	40%
Blue Cross Blue Shield	$491 - $3,662	40%
Medica [662]	$496 - $991	41%
Devoted Health Plan [847]	$508 - $1,016	42%
Cox Health Systems Insurance Company [220]	$1,158 - $2,315	95%
Health Alliance [224]	$1,158 - $2,315	95%
Allied Benefits [498]	$1,221 - $2,441	100%
Hope Trust [806]	$1,221 - $2,441	100%
Cigna	$1,309 - $2,892	107%
Healthscope Benefits [258]	$1,368 - $2,823	112%
Apwu Health Plan [216]	$1,446 - $2,892	118%
Nalc Health Benefit Plan [242]	$1,446 - $2,892	118%
Priority Health [648]	$1,446 - $2,892	118%
Healthcare Sol Mercy [609]	$1,579 - $3,157	129%
Med-Pay [480]	$1,579 - $3,157	129%
Medica [661]	$1,684 - $3,367	138%
Phcs [244]	$1,684 - $3,367	138%
Consociate [478]	$1,850 - $4,587	151%
Sarah Bush Lincoln [636]	$1,850 - $4,587	151%

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 $8,138.
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 Missouri Baptist Sullivan Hospital 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.