CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Boone County Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $403
Cash Discount Price: $400
vs. Medicare Baseline: 0.42x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Boone County Hospital is $403. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $400. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.42x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$400

Average discount available for prompt cash payment at this facility.

Insurance Median

$403

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: $400 (42%)

Insurance Median: $403 (42%)

Cash: $400 (42% of Medicare)

Ins. Median: $403 (42% 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
Choice Care Mcr Adv - All Plans	$153	16%
Humana	$153 - $469	16%
Iowa Hlth Adv - All Plans	$153	16%
Mt Carmel Hp - All Plans	$153	16%
Va Ccn-All Plans	$153	16%
Amerigroup Mcr Adv - All Other Plans	$154	16%
Aetna	$156 - $558	16%
Healthsmart Accell Network	$175	18%
UnitedHealthcare	$175 - $268	18%
Health Alliance-All Plans	$183	19%
Healthsmart Ppo - All Other Plans	$183	19%
Tricare	$184 - $209	19%
Medical Associates Hp-All Plans	$290	31%
Wellmark Hmo	$360	38%
Midlands Choice-All Plans	$392	41%
Wellmark Ppo - All Other Plans	$422	44%
Health Partners Profee Only - All Plans	$423	45%
Mutually Preferred-All Plans	$437 - $496	46%
Meridian Mcaid - All Plans	$460 - $522	48%
Iowa Total Care Mcaid - All Plans	$469 - $532	49%
Medicaid / KanCare	$474 - $537	50%

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 $400.
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 Boone County Hospital 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.