CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Flushing Hospital Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,576
Cash Discount Price: $1,394
vs. Medicare Baseline: 1.29x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Flushing Hospital Medical Center is $1,576. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,394. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.29x the Medicare baseline. Located in 45Th Avenue and Parsons Boulevard, Flushing, NY.

Cash / Self-Pay

$1,394

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,576

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: $1,394 (114%)

Insurance Median: $1,576 (129%)

Cash: $1,394 (114% of Medicare)

Ins. Median: $1,576 (129% 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
1199 National Benefit Fund	$274 - $4,001	22%
Ghi	$277 - $1,486	23%
UnitedHealthcare	$705 - $4,215	58%
Healthfirst	$1,263	103%
Fidelis	$1,412 - $1,486	115%
Aetna	$1,486 - $2,812	122%
Beacon Health Strategies	$1,486	122%
Centerlight Healthcare	$1,486	122%
Empire	$1,486 - $3,086	122%
Hip	$1,486 - $5,159	122%
Metroplus	$1,486 - $1,635	122%
Humana	$1,501 - $1,576	123%
Elderplan	$1,516	124%
Vns	$1,516	124%
Wellcare Of Ny	$1,546	126%
Villagecaremax	$1,561	128%
Senior Whole Health	$1,576	129%
Elderserve Health	$1,709	140%
Hamaspik Choice	$1,709	140%
Magnacare	$1,709 - $4,555	140%
Centers Plan For Healthy Living	$1,784	146%
Hotel Trades Council	$1,912	156%
Emblemhealth	$2,319	190%
Empire Blue Priority	$2,623	215%
Oscar	$4,018	329%
Cigna	$4,250	348%
Create Health Plan	$4,338	355%
Centivo	$4,679	383%

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 $1,394.
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 Flushing Hospital Medical Center 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.