CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Mercy Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $792
Cash Discount Price: $1,678
vs. Medicare Baseline: 0.83x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Mercy Medical Center is $792. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,678. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.83x the Medicare baseline. Located in 1320 Mercy Drive Nw, Canton, OH.

Cash / Self-Pay

$1,678

Average discount available for prompt cash payment at this facility.

Insurance Median

$792

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: $1,678 (177%)

Insurance Median: $792 (83%)

Cash: $1,678 (177% of Medicare)

Ins. Median: $792 (83% 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.

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
The Health Plan	$93 - $3,762	10%
United	$93 - $4,338	10%
Caresource	$96 - $742	10%
Buckeye	$98 - $742	10%
Amerihealth	$103 - $792	11%
Molina	$103 - $756	11%
Summacare	$112 - $1,249	12%
Oscar	$168 - $1,446	18%
Aetna	$173 - $4,001	18%
Blue Cross Blue Shield	$173 - $2,413	18%
Cigna	$173 - $1,960	18%
Humana	$173 - $842	18%
Mmo	$178 - $1,730	19%
Communicare	$181 - $885	19%
Perennial Health	$186 - $910	20%
Zing Health	$190 - $927	20%
Aultcare	$198 - $1,542	21%
Ohcp	$245 - $1,828	26%
Omas	$315 - $1,881	33%
Phphi	$378 - $2,257	40%
Gms	$441 - $2,633	46%
Immergrun	$472 - $1,881	50%
Multiplan	$567 - $3,386	60%
Cc Ehp	$1,501 - $1,524	158%
Amish Community Aid Plan	$1,693 - $1,881	178%
Ohio Healthy	$2,031	214%
Php	$2,257	238%
Medical Benefit Corp	$2,633	277%
Consociate Health	$2,822	297%
Managed Care Services	$3,010	317%
Frontpath	$3,386	356%
Tertiary Care Network	$3,386	356%

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 $1,678.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45378.
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.