CMS Price Transparency Data

Colonoscopy with biopsy

Facility: University Health System, Inc

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,037
Cash Discount Price: $489
vs. Medicare Baseline: 0.85x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at University Health System, Inc is $1,037. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $489. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.85x the Medicare baseline. Located in 1924 Alcoa Highway, Knoxville, TN.

Cash / Self-Pay

$489

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,037

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: $489 (40%)

Insurance Median: $1,037 (85%)

Cash: $489 (40% of Medicare)

Ins. Median: $1,037 (85% 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
Aetna	$183 - $1,370	15%
Blue Cross Blue Shield	$184 - $1,428	15%
Humana	$184 - $1,077	15%
Nhc	$184 - $1,141	15%
UnitedHealthcare	$184 - $1,370	15%
Cigna	$185 - $1,666	15%
American Health	$188 - $1,141	15%
Nx Health 1	$283	23%
Choicecare	$328 - $586	27%
Bluecare	$371 - $395	30%
Tenncare	$395	32%
Novanet	$452 - $782	37%
Initial Group	$612	50%
Coventry	$613 - $1,750	50%
Multiplan	$613 - $1,174	50%
First Health	$674	55%
Beechstreet	$712 - $1,468	58%
Fentress County Sheriffs Dept	$783	64%
Wellpoint	$809 - $1,141	66%
Devoted Health	$1,120	92%
Wellcare-Windsor Medadv	$1,130	92%
Medicare (plans)	$1,141 - $1,152	93%
Nx Health	$1,174	96%
Phcs	$1,174	96%
Naphcare	$1,272	104%
Prime Health	$1,468 - $1,957	120%
Seven Corners	$1,468	120%
Usa	$1,566	128%
Evolutions	$1,761	144%
Galaxy	$1,761	144%
Healthsmart	$1,761	144%

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 $489.
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 University Health System, 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.