CMS Price Transparency Data
Colonoscopy (diagnostic)
Facility: Mercy Hospital Carthage
Billing Code: 45378 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 45378
- Insurance Median: $1,005
- Cash Discount Price: $1,099
- vs. Medicare Baseline: 1.06x Medicare
The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Mercy Hospital Carthage is $1,005. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,099. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.06x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.
Cash / Self-Pay
$1,099
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,005
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: $1,099 (116%)
Insurance Median: $1,005 (106%)
Cash: $1,099 (116% of Medicare)
Ins. Median: $1,005 (106% 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicare (plans) | $190 - $853 | 20% |
| Aetna | $214 - $1,505 | 23% |
| Blue Cross Blue Shield | $214 - $1,406 | 23% |
| Centivo Contracted [320505] | $214 - $778 | 23% |
| Dept Of Veteran Affairs Contracted [320106] | $214 - $465 | 23% |
| UnitedHealthcare | $214 - $1,471 | 23% |
| Healthscope Contracted [320182] | $230 - $881 | 24% |
| Cherokee Nation Health Serv Contracted [320066] | $242 - $465 | 25% |
| Cigna | $242 - $1,522 | 25% |
| Cross Timbers Hospice [20098] | $242 - $465 | 25% |
| Elara Caring Aspire Hospice [20433] | $242 - $465 | 25% |
| Globalhealth Contracted [320145] | $242 - $465 | 25% |
| Halo Hcr Inc Hospice Contracted [320432] | $242 - $465 | 25% |
| Halo Hcr Inc Hospice [20432] | $242 - $465 | 25% |
| Humana | $242 - $507 | 25% |
| Indian Health Service Contracted [320198] | $242 - $465 | 25% |
| Kindful Hospice Contracted [320434] | $242 - $465 | 25% |
| Kindful Hospice [20434] | $242 - $465 | 25% |
| Medical Associates Health Contracted [320444] | $242 - $465 | 25% |
| Mercy Hospice Okc [20252] | $242 - $465 | 25% |
| Mercy Mgd Behavioral Health Contracted [320259] | $242 - $465 | 25% |
| Pace Of The Ozarks Contracted [320518] | $242 - $465 | 25% |
| Provider Partners Health Plans Contracted [320450] | $242 - $465 | 25% |
| Qual Choice Contracted [320325] | $242 - $465 | 25% |
| Medicaid / KanCare | $293 - $928 | 31% |
| Tricare | $374 - $466 | 39% |
| Health Systems Inc Contracted [320174] | $485 - $727 | 51% |
| Insurance System Inc Contracted [320465] | $485 - $727 | 51% |
| Point C Contracted [320238] | $592 - $1,522 | 62% |
| Administrative Payor Contracted [320005] | $611 - $761 | 64% |
| Ambetter / Centene | $746 - $928 | 79% |
| Home State Health Plan Contracted [320187] | $746 - $928 | 79% |
| Novasys Contracted [320285] | $746 - $928 | 79% |
| Benefit Management Contracted [320052] | $815 - $1,471 | 86% |
| Auxiant Contracted [320462] | $883 - $1,437 | 93% |
| Healthlink Contracted [320179] | $883 - $1,573 | 93% |
| Preferred Health Plan Contracted [320522] | $883 - $1,099 | 93% |
| Workers Comp [20426] | $1,086 - $1,691 | 114% |
| United Medical Resources Contracted [320454] | $1,127 - $1,522 | 119% |
| 90 Degree Benefits Contracted [320436] | $1,154 - $1,437 | 121% |
| Aither Health Contracted [320449] | $1,154 - $1,437 | 121% |
| Ebms Contracted [320493] | $1,154 - $1,437 | 121% |
| Edison Health Solutions Contracted [320502] | $1,154 - $1,437 | 121% |
| Imagine 360 Contracted [320494] | $1,154 - $1,437 | 121% |
| Mercy Benefit Admin Contracted [320251] | $1,154 - $1,522 | 121% |
| Reflect Health Contracted [320492] | $1,154 - $1,437 | 121% |
| Show-Me Health Administrators Contracted [320483] | $1,154 - $1,437 | 121% |
| Yuzu Health Contracted [320521] | $1,154 - $1,437 | 121% |
| Medica Contracted [320239] | $1,176 - $1,464 | 124% |
| Evolutions Health Care Contracted [320124] | $1,181 - $1,471 | 124% |
| First Health Contracted [320128] | $1,181 - $1,471 | 124% |
| Multiplan Contracted [320270] | $1,181 - $1,471 | 124% |
| Private Health Care Systems Contracted [320320] | $1,181 - $1,471 | 124% |
| American Healthcare Alliance Contracted [320020] | $1,222 - $1,522 | 129% |
| Ppo Plus Contracted [320310] | $1,222 - $1,522 | 129% |
| Usa Managed Care Org Contracted [320429] | $1,222 - $1,522 | 129% |
| Health Choice Contracted [320166] | $1,823 | 192% |