CMS Price Transparency Data

Colonoscopy with biopsy

Facility: The Children's Mercy Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $483
Cash Discount Price: $463
vs. Medicare Baseline: 0.40x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at The Children's Mercy Hospital is $483. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $463. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.40x the Medicare baseline. Located in 2401 Gillham Road, Kansas City, MO.

Cash / Self-Pay

$463

Average discount available for prompt cash payment at this facility.

Insurance Median

$483

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: $463 (38%)

Insurance Median: $483 (40%)

Cash: $463 (38% of Medicare)

Ins. Median: $483 (40% 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
Healthlink	$247	20%
Health Midwest Comprehensive Care	$265	22%
American Healthcare Alliance	$281	23%
Quiktrip	$347	28%
Wellfit/Centrus	$367	30%
Centivo	$378	31%
Nebraska Furniture Mart	$381	31%
UnitedHealthcare	$411 - $769	34%
Multiplan	$430	35%
Healthy Blue	$438 - $468	36%
Blue Cross Blue Shield	$441 - $760	36%
Medicaid / KanCare	$442	36%
Aetna	$443 - $506	36%
Home State Health	$468	38%
Humana	$478	39%
Orscheln	$483	40%
Wppa Providrs Care	$529	43%
Cigna	$535	44%
Coventry Health Care Of Kansas	$560	46%
Medica	$563	46%
Mercy Health	$704	58%
Coxhealth Network	$714	58%
National Preferred Provider Network	$849	69%

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 $463.
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 The Children's Mercy 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.