CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Montefiore Mount Vernon Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,494
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Montefiore Mount Vernon Hospital is $1,494. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.22x the Medicare baseline. Located in 12 North 7Th Avenue, Mount Vernon, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,494

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%)

Insurance Median: $1,494 (122%)

Ins. Median: $1,494 (122% 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
American Postal Workers	$204 - $13,302	17%
UnitedHealthcare	$204 - $13,302	17%
Metroplus	$222 - $1,942	18%
Healthfirst	$643 - $1,494	53%
Amidacare	$834	68%
Blue Cross Blue Shield	$834 - $10,052	68%
Emblem	$834 - $9,640	68%
Fidelis	$834 - $1,494	68%
Medicaid / KanCare	$834	68%
Molina Healthcare Of Ny Affinity	$834 - $2,061	68%
Mvp	$834 - $1,709	68%
Wellcare	$842 - $1,524	69%
Hamaspik	$875 - $900	72%
Vnsny Choice	$959 - $1,494	78%
Vnsny Select Health	$959	78%
Point Comfort	$1,494	122%
Villagecaremax	$1,494	122%
Centerlight	$1,539 - $1,643	126%
Elderplan	$1,539	126%
Partners Health Plan	$1,568	128%
Longevity	$1,628	133%
Humana	$1,643	134%
Oscar	$1,908 - $7,276	156%
Aetna	$3,885 - $4,346	318%
Northwell	$4,018	329%

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 $X.
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 Montefiore Mount Vernon Hospital 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.