CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Mercy Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $956
Cash Discount Price: $2,076
vs. Medicare Baseline: 0.78x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Mercy Medical Center is $956. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,076. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.78x the Medicare baseline. Located in 1320 Mercy Drive Nw, Canton, OH.

Cash / Self-Pay

$2,076

Average discount available for prompt cash payment at this facility.

Insurance Median

$956

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: $2,076 (170%)

Insurance Median: $956 (78%)

Cash: $2,076 (170% of Medicare)

Ins. Median: $956 (78% 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
Summacare	$122 - $1,613	10%
Aetna	$188 - $4,858	15%
Blue Cross Blue Shield	$188 - $3,115	15%
Cigna	$188 - $2,531	15%
Humana	$188 - $1,089	15%
Oscar	$188 - $1,868	15%
The Health Plan	$188 - $4,858	15%
United	$188 - $4,338	15%
Mmo	$193 - $2,233	16%
Communicare	$197 - $1,144	16%
Perennial Health	$203 - $1,177	17%
Zing Health	$206 - $1,198	17%
Caresource	$209 - $742	17%
Buckeye	$213 - $742	17%
Aultcare	$216 - $1,992	18%
Amerihealth	$223 - $792	18%
Molina	$223 - $756	18%
Ohcp	$275 - $2,361	22%
Omas	$353 - $2,429	29%
Phphi	$424 - $2,915	35%
Gms	$494 - $3,401	40%
Immergrun	$530 - $2,429	43%
Multiplan	$635 - $4,372	52%
Cc Ehp	$1,938 - $1,967	159%
Amish Community Aid Plan	$2,186 - $2,429	179%
Ohio Healthy	$2,623	215%
Php	$2,915	238%
Medical Benefit Corp	$3,401	278%
Consociate Health	$3,644	298%
Frontpath	$4,372	358%
Managed Care Services	$4,372	358%
Tertiary Care Network	$4,372	358%

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 $2,076.
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 Mercy Medical Center 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.