CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Mercy Hospital Carthage

Billing Code: 45380 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$428

about 0.3× the $1,223 Medicare rate · typically $353–$1,333

modeled estimate · not a bill or quote

What this hospital charges insurers

$372

Below the fair price — a good deal

about $56 under the fair price · 0.3× Medicare

Medicare pays $1,223 Fair price $428 This hospital $372 Cash price $2,367 Hospital's list price $3,641

How we calculate the fair BaseRate →

How this hospital compares to other MO hospitals

Highest price of the 9 MO hospitals we have prices for — worth calling around.

Cheapest $171 Priciest $372

Black dot = this hospital, among the 9 MO hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Colonoscopy with biopsy is about $428 (about 0.3× the $1,223 Medicare rate). Mercy Hospital Carthage charges insurers about $372, or about $2,367 in cash — below the fair price — a good deal. Located in Carthage, MO.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$202 - $1,563	17%
Blue Cross Blue Shieldmajor	$233 - $1,406	19%
Aetnamajor	$233 - $372	19%
Cignamajor	$290 - $383	24%
Humanamajor	$243 - $372	20%
Ambetter (Centene)	$283	23%
HealthLink	$268 - $1,476	22%
+ 36 smaller / regional plans	$202 - $2,358

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 8 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 2,367), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 45380.

Insurance Before you use insurance

Call your insurance company to confirm Mercy Hospital Carthage is in-network.
Ask your insurer whether prior approval is required for CPT code 45380.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Mercy Hospital Carthage

Compare: Colonoscopy with biopsy at other MO hospitals

Insurance negotiated median for the same procedure, sorted lowest first.