CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: University of Iowa Health Care Medical Center Down

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $2,097
Cash Discount Price: $2,935
vs. Medicare Baseline: 2.21x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at University of Iowa Health Care Medical Center Down is $2,097. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,935. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 2.21x the Medicare baseline. Located in 500 E Market Street, Iowa City, IA.

Cash / Self-Pay

$2,935

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,097

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: $2,935 (309%)

Insurance Median: $2,097 (221%)

Cash: $2,935 (309% of Medicare)

Ins. Median: $2,097 (221% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 221% of the Medicare baseline (a markup of 121%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$165 - $3,089	17%
Iowa Total Care	$165 - $1,677	17%
Medical Associates	$165 - $2,809	17%
Molina Healthcare	$165 - $1,677	17%
UnitedHealthcare	$165 - $6,174	17%
Blue Cross Blue Shield	$166 - $2,013	17%
Healthpartners	$168 - $3,564	18%
Wellpoint (Amerigroup)	$173 - $901	18%
Immergrun	$584 - $1,048	61%
Quad City Community Healthcare	$594 - $3,145	63%
Aplos Health Plan	$782 - $3,354	82%
Midlands Choice	$1,107 - $2,725	117%
Oscar Health	$1,471 - $2,642	155%
Great River Health Systems	$1,634 - $2,935	172%
Sedgwick	$1,868 - $3,354	197%
Global Excel	$1,985 - $3,564	209%
Sanford Health Plan	$1,985 - $3,564	209%
Employee Benefit Systems	$2,055 - $3,774	216%
Sisco	$2,055 - $3,690	216%
Healthsmart	$2,102 - $3,774	221%
Hfn	$2,148 - $3,858	226%
Multiplan	$2,148 - $3,858	226%

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 $2,935.
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 University of Iowa Health Care Medical Center Down 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.