CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: University Health System, Inc

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $875
Cash Discount Price: $544
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at University Health System, Inc is $875. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $544. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.92x the Medicare baseline. Located in 1924 Alcoa Highway, Knoxville, TN.

Cash / Self-Pay

$544

Average discount available for prompt cash payment at this facility.

Insurance Median

$875

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: $544 (57%)

Insurance Median: $875 (92%)

Cash: $544 (57% of Medicare)

Ins. Median: $875 (92% 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
Aetna	$84 - $1,522	9%
Blue Cross Blue Shield	$85 - $1,428	9%
Cigna	$85 - $1,666	9%
Humana	$85 - $832	9%
Nhc	$85 - $882	9%
UnitedHealthcare	$85 - $1,522	9%
American Health	$87 - $882	9%
Signature	$87	9%
Wellpoint	$87 - $882	9%
Novanet	$107 - $223	11%
Choicecare	$155	16%
Initial Group	$171	18%
Coventry	$173 - $1,750	18%
First Health	$190	20%
Devoted Health	$866	91%
Fentress County Sheriffs Dept	$870	92%
Wellcare-Windsor Medadv	$874	92%
Medicare (plans)	$882 - $891	93%
Multiplan	$1,304	137%
Nx Health	$1,304	137%
Phcs	$1,304	137%
Naphcare	$1,413	149%
Beechstreet	$1,630	172%
Prime Health	$1,630 - $2,174	172%
Seven Corners	$1,630	172%
Usa	$1,739	183%
Evolutions	$1,957	206%
Galaxy	$1,957	206%
Healthsmart	$1,957	206%

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 $544.
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 Health System, Inc 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.