CMS Price Transparency Data

Colonoscopy with biopsy

Facility: NYU Langone Hospitals

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,459
Cash Discount Price: $419
vs. Medicare Baseline: 2.01x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at NYU Langone Hospitals is $2,459. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $419. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 2.01x the Medicare baseline. Located in 550 First Avenue, New York, NY.

Cash / Self-Pay

$419

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,459

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: $419 (34%)

Insurance Median: $2,459 (201%)

Cash: $419 (34% of Medicare)

Ins. Median: $2,459 (201% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 201% of the Medicare baseline (a markup of 101%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$575 - $2,459	47%
Amida	$1,093	89%
Fidelis	$1,093 - $2,459	89%
Healthplus	$1,093 - $2,459	89%
Hip	$1,093 - $8,427	89%
Medicaid / KanCare	$1,093	89%
Metroplus	$1,093 - $2,763	89%
UnitedHealthcare	$1,093 - $8,512	89%
Somos	$1,148 - $1,475	94%
Ghi	$1,395 - $12,574	114%
Medicare (plans)	$1,395	114%
Wellcare	$1,395	114%
Centerlight	$1,423	116%
Multiplan	$1,721	141%
Aetna	$2,206 - $6,733	180%
Hamaspik	$2,790 - $4,412	228%
Oscar	$4,038	330%
1199	$5,050 - $5,941	413%
Oxford	$5,300 - $6,954	434%
Cigna	$5,479	448%
Blue Cross Blue Shield	$5,867 - $7,334	480%
Magnacare	$6,726 - $13,453	550%

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 $419.
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 NYU Langone Hospitals 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.