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CMS Price Transparency Data Hospital file updated: 4/1/2026

Colonoscopy with biopsy

Facility: Mercy Health - Defiance Hospital

Billing Code: 45380 (CPT)

Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Good Deal · Below Fair Market
$1,292Fair BaseRate (0.92× Market)
Position vs. 1.00× Fair Price8% Below Fair Price 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

This hospital's typical commercial price is $1,191 compared to the $1,292 fair price benchmark.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.Regional Value Leader
CMS Star Rating4/5 StarsOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety Score78/100Composite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

4-Star CMS clinical quality rating paired with 0.92× fair market pricing.

The BaseRate · fair price high confidence
A fair price for this
$1,292
about 1.1× the $1,223 Medicare rate · typically $1,099–$1,914
modeled estimate · not a bill or quote
What this hospital charges insurers
$1,191
About the fair price
about $101 under the fair price · 1.0× Medicare
Medicare pays $1,223 Fair price $1,292 This hospital $1,191 Cash price $7,913 Hospital's list price $13,189

How we calculate the fair BaseRate →

How this hospital compares to other OH hospitals

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

Cheapest $175 Priciest $1,191

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

Note: 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 $1,292 (about 1.1× the $1,223 Medicare rate). Mercy Health - Defiance Hospital charges insurers about $1,191, or about $7,913 in cash — about the fair price. Located in Defiance, OH.

What each insurance company pays

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

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

UnitedHealthcareAetnaHumana Blue Cross Blue ShieldCignaKaiser 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 $1,190 97%
Aetnamajor $1,190 97%
Humanamajor $1,190 97%
CareSource $1,214 99%

Self-Pay How to get the cash price

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Facility Profile & Credentials

  • Address: 1404 East Second Street, Defiance, OH 43512
  • CMS Rating: 4 / 5 Stars
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals

Other Procedures at Mercy Health - Defiance Hospital

Compare: Colonoscopy with biopsy at other OH hospitals

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

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%

Audit a Bill or Quote at Mercy Health - Defiance Hospital (Zero PHI Required)

CMS CCN: 360270
CPT 45380
Fair BaseRate™ $1,292
Medicare Rate $1,223
Self-Pay Cash $7,913
Insurer Median $1,191
Pre-filled with Mercy Health - Defiance Hospital’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $4,788 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $4,788

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $4,788).

Step 2 · Cash vs. Insurance Arbitrage Save $5,276 Paying Cash

Self-Pay Cash Rate ($7,913) Beats Your Bill

Mercy Health - Defiance Hospital's published 45 CFR § 180 self-pay cash rate is $7,913 (vs. $1,191 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$11,897 Above Fair BaseRate

Negotiate Toward $1,292 Fair BaseRate ($1,223 Medicare)

Your bill ($13,189) is $11,897 above the denoised Fair BaseRate ($1,292) and 10.8× the $1,223 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

CMS Overall4/5 Stars (4/5)

Source: CMS Hospital Care Compare. Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

45 CFR § 180 Primary-Source Lineage & Federal Verification Verified CMS CCN 360270

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (020701635_mercy-health-defiance-hospital-llc_standardcharges.ashx) Verify on CMS Medicare.gov (CCN 360270) ↗ CMS HCRIS Cost Reports ↗
Published MRF File020701635_mercy-health-defiance-hospital-llc_standardcharges.ashx
Publication / Vintage4/1/2026 · 15.63 MB
Validated Rate Rows11,051 (CMS v3.0.0)
File Integrity Digest3b5d5355c8779635d0fc…

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

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