CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Mt Sinai Hospital Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,282
Cash Discount Price: $1,052
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Mt Sinai Hospital Medical Center is $1,282. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,052. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.05x the Medicare baseline. Located in 15Th Street at California, Chicago, IL.

Cash / Self-Pay

$1,052

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,282

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: $1,052 (86%)

Insurance Median: $1,282 (105%)

Cash: $1,052 (86% of Medicare)

Ins. Median: $1,282 (105% 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
Oscar - All Plans	$526	43%
Partners In Hlth - All Plans	$601	49%
Blue Cross Blue Shield	$672 - $1,499	55%
Compsych Ip/Op Only - All Plans	$902	74%
Healthlink Hmo	$977	80%
Hfn Platinum	$977	80%
Healthlink Ppo - All Other Plans	$1,052	86%
Multiplan Primary Ntwrk/Phcs - All Other Plans	$1,052	86%
Hfn Epo	$1,202	98%
Multiplan Complementary Ntwrk	$1,202	98%
Cigna	$1,205 - $1,857	99%
Tricare	$1,244	102%
Va Healthnet - All Plans	$1,244	102%
Advocate Physician Prtnrs Mcr	$1,282	105%
Cenpatico Illinicare Dual	$1,282	105%
Cenpatico Illinicare Mcr - All Other Plans	$1,282	105%
Humana	$1,282 - $4,718	105%
Lawndale Christian - All Plans	$1,282	105%
Meridian/Harmony D-Snp - All Plans	$1,282	105%
Nextlevel Hlth Icp Fhp Aca - All Plans	$1,282	105%
Harmony Behavioral Htlh - All Plans	$1,321	108%
Hfn Ppo - All Other Plans	$1,322	108%
Zing Mcr Adv - All Plans	$1,334	109%
Molina Mcr - All Other Plans	$1,346	110%
Advocate Physician Prtnrs - All Other Plans	$1,411	115%
Ambetter / Centene	$1,411 - $1,578	115%
Aetna	$1,499 - $3,396	123%
Family Health Network Mcaid - All Plans	$1,499	123%
Molina Mcaid	$1,574	129%

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 $1,052.
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 Mt Sinai Hospital Medical Center 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.