CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Mercy Hospital Ardmore, Inc

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,178
Cash Discount Price: $3,350
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Mercy Hospital Ardmore, Inc is $1,178. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,350. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.96x the Medicare baseline. Located in 1011 14Th Ave Nw, Ardmore, OK.

Cash / Self-Pay

$3,350

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,178

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: $3,350 (274%)

Insurance Median: $1,178 (96%)

Cash: $3,350 (274% of Medicare)

Ins. Median: $1,178 (96% 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
Blue Cross Blue Shield	$185 - $1,179	15%
Aetna	$1,178	96%
Cherokee Nation Health Serv Contracted [320066]	$1,178	96%
Cross Timbers Hospice [20098]	$1,178	96%
Dept Of Veteran Affairs Contracted [320106]	$1,178	96%
Elara Caring Aspire Hospice Contracted [320433]	$1,178	96%
Elara Caring Aspire Hospice [20433]	$1,178	96%
Halo Hcr Inc Hospice Contracted [320432]	$1,178	96%
Halo Hcr Inc Hospice [20432]	$1,178	96%
Independent Health [20197]	$1,178	96%
Indian Health Service Contracted [320198]	$1,178	96%
Kindful Hospice Contracted [320434]	$1,178	96%
Kindful Hospice [20434]	$1,178	96%
Medical Associates Health [20444]	$1,178	96%
Medicare (plans)	$1,178 - $1,249	96%
Mercy Hospice Okc [20252]	$1,178	96%
Provider Partners Health Plans Contracted [320450]	$1,178	96%
Qual Choice Contracted [320325]	$1,178	96%
Tribute Health Plan Mcr Contracted [320338]	$1,178	96%
Tricare	$1,178	96%
Humana	$1,201	98%
UnitedHealthcare	$1,201	98%
Globalhealth Contracted [320145]	$1,202	98%
Cigna	$1,214 - $3,261	99%
Ambetter / Centene	$1,622	133%
Home State Health Plan Contracted [320187]	$1,622	133%
Medicaid / KanCare	$1,622	133%
Novasys Contracted [320285]	$1,622	133%
Community Care Contracted [320080]	$1,802	147%
Workers Comp [20426]	$1,968	161%
Health Choice Contracted [320166]	$2,358	193%
Healthsmart Preferred Care Contracted [320184]	$2,651	217%
Kempton Contracted [320214]	$2,651	217%

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 $3,350.
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 Hospital Ardmore, Inc 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.