CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Maimonides Medical Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $204
Cash Discount Price: $2,078
vs. Medicare Baseline: 0.21x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Maimonides Medical Center is $204. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,078. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.21x the Medicare baseline. Located in 4802 Tenth Avenue, Brooklyn, NY.

Cash / Self-Pay

$2,078

Average discount available for prompt cash payment at this facility.

Insurance Median

$204

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: $2,078 (219%)

Insurance Median: $204 (21%)

Cash: $2,078 (219% of Medicare)

Ins. Median: $204 (21% 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 Health - Hip	$42 - $369	4%
Wellcare	$51 - $204	5%
Blue Cross Blue Shield	$53 - $4,181	6%
Healthfirst	$65 - $1,138	7%
UnitedHealthcare	$81 - $4,574	9%
Fidelis	$94 - $281	10%
Aetna	$104 - $1,161	11%
Emblem Health - Hip Vip	$104 - $209	11%
Local 1199	$116 - $2,516	12%
Metroplus	$142 - $1,393	15%
Elderplan	$173	18%
United Community Plan	$174 - $1,277	18%
Visiting Nurse Svc Of Ny	$177 - $262	19%
Centers Plan For Healthy Living	$208	22%
Molina	$208 - $232	22%
Cigna	$232 - $346	24%
Elderserve Health	$240	25%
Emblem Health - Ghi	$262 - $3,529	28%
Oxford Health Plan	$262 - $4,574	28%
Oxford Liberty	$282 - $4,574	30%
Magnacare	$5,830	614%
Centivo	$6,360	669%

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 $2,078.
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 Maimonides Medical 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.