CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Montefiore Mount Vernon Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,161
Cash Discount Price: $8,366
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Montefiore Mount Vernon Hospital is $1,161. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,366. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.22x the Medicare baseline. Located in 12 North 7Th Avenue, Mount Vernon, NY.

Cash / Self-Pay

$8,366

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,161

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: $8,366 (881%)

Insurance Median: $1,161 (122%)

Cash: $8,366 (881% of Medicare)

Ins. Median: $1,161 (122% 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
American Postal Workers	$188 - $13,302	20%
UnitedHealthcare	$188 - $13,302	20%
Metroplus	$204 - $1,509	21%
Healthfirst	$643 - $1,359	68%
Amidacare	$834	88%
Blue Cross Blue Shield	$834 - $6,702	88%
Emblem	$834 - $10,297	88%
Fidelis	$834 - $1,459	88%
Medicaid / KanCare	$834	88%
Molina Healthcare Of Ny Affinity	$834 - $1,876	88%
Mvp	$834 - $1,709	88%
Wellcare	$842 - $1,184	89%
Hamaspik	$875 - $900	92%
Vnsny Choice	$959 - $1,161	101%
Vnsny Select Health	$959	101%
Aetna	$1,075 - $4,346	113%
Point Comfort	$1,161	122%
Villagecaremax	$1,161	122%
Centerlight	$1,196 - $1,277	126%
Elderplan	$1,196	126%
Partners Health Plan	$1,219	128%
Longevity	$1,265	133%
Humana	$1,277	134%
Oscar	$1,908 - $9,846	201%
Northwell	$3,123	329%
Centivo	$8,109	853%

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 $8,366.
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 Montefiore Mount Vernon 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.