CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Mt Sinai Hospital Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $997
Cash Discount Price: $942
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Mt Sinai Hospital Medical Center is $997. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $942. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.05x the Medicare baseline. Located in 15Th Street at California, Chicago, IL.

Cash / Self-Pay

$942

Average discount available for prompt cash payment at this facility.

Insurance Median

$997

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: $942 (99%)

Insurance Median: $997 (105%)

Cash: $942 (99% of Medicare)

Ins. Median: $997 (105% 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
Lawndale Christian - All Plans	$399 - $1,803	42%
Oscar - All Plans	$477 - $841	50%
Blue Cross Blue Shield	$530 - $1,499	56%
Partners In Hlth - All Plans	$532 - $559	56%
Cigna	$748 - $1,898	79%
Compsych Ip/Op Only - All Plans	$798 - $838	84%
Healthlink Hmo	$864 - $908	91%
Hfn Platinum	$864 - $3,323	91%
UnitedHealthcare	$885 - $1,315	93%
Healthlink Ppo - All Other Plans	$930 - $977	98%
Multiplan Primary Ntwrk/Phcs - All Other Plans	$930 - $977	98%
Tricare	$967	102%
Va Healthnet - All Plans	$967	102%
Advocate Physician Prtnrs Mcr	$997	105%
Cenpatico Illinicare Dual	$997	105%
Cenpatico Illinicare Mcr - All Other Plans	$997	105%
Humana	$997 - $4,385	105%
Meridian/Harmony D-Snp - All Plans	$997	105%
Nextlevel Hlth Icp Fhp Aca - All Plans	$997	105%
Harmony Behavioral Htlh - All Plans	$1,026	108%
Zing Mcr Adv - All Plans	$1,036	109%
Molina Mcr - All Other Plans	$1,046	110%
Hfn Epo	$1,063 - $3,323	112%
Multiplan Complementary Ntwrk	$1,063 - $1,117	112%
Advocate Physician Prtnrs - All Other Plans	$1,096	115%
Ambetter / Centene	$1,096 - $1,466	115%
Hfn Ppo - All Other Plans	$1,170 - $1,229	123%
Aetna	$1,499 - $3,156	158%
Family Health Network Mcaid - All Plans	$1,499	158%
Molina Mcaid	$1,574	166%

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 $942.
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 Mt Sinai Hospital Medical Center 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.