CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Merit Health Madison

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,977
Cash Discount Price: $1,102
vs. Medicare Baseline: 1.62x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Merit Health Madison is $1,977. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,102. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.62x the Medicare baseline. Located in 161 River Oaks Drive, Canton, MS.

Cash / Self-Pay

$1,102

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,977

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: $1,102 (90%)

Insurance Median: $1,977 (162%)

Cash: $1,102 (90% of Medicare)

Ins. Median: $1,977 (162% 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
Advhealth	$666	54%
Blue Cross Blue Shield	$693	57%
Ms-Can-Molina	$925	76%
Ms-Can-Magnolia	$934	76%
Ms-Can-Truecare	$943	77%
Medicare (plans)	$1,080	88%
Wellcare	$1,113	91%
Humana	$1,124	92%
Devoted_Health	$1,134	93%
Molina-Chip	$1,977	162%
Magnolia-Chip	$2,022	165%
Truecare-Chip	$2,022	165%
United_Exchange	$2,104	172%
Mpcn	$2,109	173%
Firstchoice	$2,161	177%
Molina_Exchange	$2,323	190%
United	$2,440	200%
Cigna	$2,512	205%
Ambetter / Centene	$2,756	225%

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 $1,102.
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 Merit Health Madison 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.