CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Kings County Hospital Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $970
Cash Discount Price: $1,351
vs. Medicare Baseline: 0.79x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Kings County Hospital Center is $970. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,351. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.79x the Medicare baseline. Located in 451 Clarkson Avenue, Brooklyn, NY.

Cash / Self-Pay

$1,351

Average discount available for prompt cash payment at this facility.

Insurance Median

$970

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: $1,351 (111%)

Insurance Median: $970 (79%)

Cash: $1,351 (111% of Medicare)

Ins. Median: $970 (79% 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
Healthfirst	$113 - $2,140	9%
Affinity	$199 - $2,140	16%
Blue Cross Blue Shield	$227 - $3,402	19%
Centerlight	$227 - $2,126	19%
Elderplan	$227 - $2,764	19%
Fidelis	$227 - $2,140	19%
Wellcare	$230 - $2,552	19%
Centers Plan For Healthy Living	$236 - $1,451	19%
Hamaspik	$238	19%
Aetna	$240 - $2,177	20%
Metroplus	$265 - $2,140	22%
Local 1199	$274 - $3,615	22%
Oscar	$283 - $4,454	23%
Emblem	$319 - $4,821	26%
Magnacare	$320 - $3,190	26%
Oxford	$362 - $2,648	30%
United	$434 - $3,275	35%
Carelon	$758 - $2,764	62%
Amidacare	$951	78%
Senior Whole Health	$951	78%
United Behavioral Health	$951 - $1,046	78%
Carelon (Amida Care)	$970	79%
Vnsny	$970 - $3,615	79%
Vaccn	$1,395	114%
Cigna	$1,500 - $4,285	123%
Multiplan	$3,260 - $3,402	267%
Villagecare Max	$3,464 - $3,615	283%

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 $1,351.
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 Kings County Hospital 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.