CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Memorial Hospital for Cancer and Allied Diseases

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $836
Cash Discount Price: $1,635
vs. Medicare Baseline: 0.88x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Memorial Hospital for Cancer and Allied Diseases is $836. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,635. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.88x the Medicare baseline. Located in 1275 York Ave, New York, NY.

Cash / Self-Pay

$1,635

Average discount available for prompt cash payment at this facility.

Insurance Median

$836

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: $1,635 (172%)

Insurance Median: $836 (88%)

Cash: $1,635 (172% of Medicare)

Ins. Median: $836 (88% 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
Emblem	$103 - $861	11%
Aetna	$203 - $7,501	21%
Fidelis	$203	21%
Healthfirst	$203 - $588	21%
Metroplus	$203	21%
Empire	$772 - $5,367	81%
Oxford	$981 - $8,400	103%
Cigna	$1,122 - $7,041	118%
Magnacare	$1,177 - $1,308	124%
UnitedHealthcare	$1,212 - $9,727	128%
Urn	$1,275	134%
6 Degrees Health	$1,308	138%
Multiplan	$1,472	155%

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 $1,635.
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 Memorial Hospital for Cancer and Allied Diseases 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.