CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Memorial Hospital for Cancer and Allied Diseases

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,286
Cash Discount Price: $2,639
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Memorial Hospital for Cancer and Allied Diseases is $1,286. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,639. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.05x the Medicare baseline. Located in 1275 York Ave, New York, NY.

Cash / Self-Pay

$2,639

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,286

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: $2,639 (216%)

Insurance Median: $1,286 (105%)

Cash: $2,639 (216% of Medicare)

Ins. Median: $1,286 (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
Emblem	$162 - $2,681	13%
Aetna	$221 - $9,784	18%
Fidelis	$221 - $2,476	18%
Healthfirst	$221 - $2,201	18%
Metroplus	$221 - $2,257	18%
Empire	$845 - $7,290	69%
Oxford	$1,058 - $8,400	87%
Cigna	$1,217 - $7,041	100%
Magnacare	$1,300 - $2,778	106%
UnitedHealthcare	$1,307 - $9,727	107%
Urn	$1,408 - $2,465	115%
6 Degrees Health	$1,444 - $2,708	118%
Multiplan	$1,624 - $3,125	133%

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 $2,639.
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 Memorial Hospital for Cancer and Allied Diseases 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.