CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Knoxville Hospital & Clinics

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $386
Cash Discount Price: $775
vs. Medicare Baseline: 0.41x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Knoxville Hospital & Clinics is $386. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $775. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.41x the Medicare baseline. Located in 1002 South Lincoln Street, Knoxville, IA.

Cash / Self-Pay

$775

Average discount available for prompt cash payment at this facility.

Insurance Median

$386

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: $775 (82%)

Insurance Median: $386 (41%)

Cash: $775 (82% of Medicare)

Ins. Median: $386 (41% 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
Oscar-All Plans	$153	16%
UnitedHealthcare	$153 - $175	16%
Amerigroup Mcr - All Other Plans	$154	16%
Medical Associates Health Plan-All Other Plans	$160	17%
Wellmark Hmo 7/1/22	$350	37%
Midlands Choice-All Plans	$377	40%
Cigna	$386	41%
Health Partners New Bus	$386	41%
Health Partners-All Other Plans	$386	41%
Wellmark Ppo 7/1/22-All Other Plans	$422	44%
Humana	$1,097	115%
Iowa Total Care Mcaid - All Plans	$1,291	136%
Molina Mcaid/Chip - All Plans	$1,323	139%
Amerigroup Mcaid	$1,356	143%

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 $775.
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 Knoxville Hospital & Clinics 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.