CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Kings County Hospital Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $951
Cash Discount Price: $1,046
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Kings County Hospital Center is $951. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,046. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.00x the Medicare baseline. Located in 451 Clarkson Avenue, Brooklyn, NY.

Cash / Self-Pay

$1,046

Average discount available for prompt cash payment at this facility.

Insurance Median

$951

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: $1,046 (110%)

Insurance Median: $951 (100%)

Cash: $1,046 (110% of Medicare)

Ins. Median: $951 (100% 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
Healthfirst	$84 - $2,140	9%
Amidacare	$105 - $951	11%
Emblem	$105 - $4,821	11%
Aetna	$111 - $2,177	12%
Wellcare	$113 - $225	12%
Fidelis	$151 - $2,140	16%
Oscar	$157 - $4,454	17%
Affinity	$183 - $2,140	19%
Blue Cross Blue Shield	$208 - $2,140	22%
Centerlight	$208 - $1,678	22%
Elderplan	$208 - $1,079	22%
Centers Plan For Healthy Living	$217 - $1,122	23%
Hamaspik	$219	23%
Local 1199	$232 - $2,334	24%
Metroplus	$245 - $2,140	26%
Carelon	$951 - $2,181	100%
Senior Whole Health	$951	100%
United	$951 - $3,275	100%
United Behavioral Health	$951 - $1,046	100%
Carelon (Amida Care)	$970	102%
Vnsny	$970 - $1,079	102%
Vaccn	$1,079	114%
Oxford	$2,337 - $2,648	246%
Magnacare	$2,517	265%
Multiplan	$2,684	282%
Villagecare Max	$2,852	300%
Cigna	$4,285	451%

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 $1,046.
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 Kings County Hospital 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.