CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Maimonides Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $192
Cash Discount Price: $2,330
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Maimonides Medical Center is $192. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,330. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.16x the Medicare baseline. Located in 4802 Tenth Avenue, Brooklyn, NY.

Cash / Self-Pay

$2,330

Average discount available for prompt cash payment at this facility.

Insurance Median

$192

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: $2,330 (191%)

Insurance Median: $192 (16%)

Cash: $2,330 (191% of Medicare)

Ins. Median: $192 (16% 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
United Community Plan	$52 - $1,643	4%
Blue Cross Blue Shield	$53 - $6,226	4%
Aetna	$73 - $1,494	6%
Healthfirst	$77 - $1,464	6%
UnitedHealthcare	$96 - $4,574	8%
Fidelis	$102 - $306	8%
Molina	$113 - $227	9%
Cigna	$143 - $357	12%
Metroplus	$154 - $1,792	13%
Emblem Health - Hip	$162 - $585	13%
Oxford Liberty	$182 - $4,574	15%
Healthfirst Early Start	$185	15%
Elderplan	$192	16%
Visiting Nurse Svc Of Ny	$215	18%
Emblem Health - Hip Vip	$222	18%
Wellcare	$222	18%
Villagecare Maxx Fida	$238	19%
Local 1199	$274 - $2,516	22%
Magnacare	$285 - $5,830	23%
Oxford Health Plan	$357 - $4,574	29%
Emblem Health - Ghi	$390 - $4,541	32%
Centivo	$6,360	520%

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 $2,330.
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 Maimonides 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.