CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Elmhurst Hospital Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,026
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.08x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Elmhurst Hospital Center is $1,026. 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 $950.1, this hospital’s rate is 1.08x the Medicare baseline. Located in 79-01 Broadway, Elmhurst, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,026

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%)

Insurance Median: $1,026 (108%)

Ins. Median: $1,026 (108% 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
Healthfirst	$81 - $2,098	9%
Amidacare	$101 - $932	11%
Emblem	$101 - $4,821	11%
Wellcare	$109 - $218	11%
Aetna	$111 - $2,177	12%
Fidelis	$146 - $2,098	15%
Oscar	$152 - $4,454	16%
Metroplus	$245 - $2,098	26%
Blue Cross Blue Shield	$932 - $2,098	98%
Carelon	$932 - $1,746	98%
Senior Whole Health	$932	98%
United	$932 - $3,275	98%
United Behavioral Health	$932 - $1,026	98%
Affinity	$951 - $2,098	100%
Carelon (Amida Care)	$951	100%
Vnsny	$951 - $1,079	100%
Elderplan	$1,079	114%
Vaccn	$1,079	114%
Centers Plan For Healthy Living	$1,122	118%
Centerlight	$1,343	141%
Magnacare	$2,014	212%
Multiplan	$2,149	226%
Villagecare Max	$2,283	240%
Local 1199	$2,334	246%
Oxford	$2,337 - $2,648	246%
Cigna	$4,285	451%

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: 45378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Elmhurst Hospital 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.