CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Harlem Hospital Center

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,042
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Harlem Hospital Center is $1,042. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.10x the Medicare baseline. Located in 506 Lenox Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,042

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%)

Insurance Median: $1,042 (110%)

Ins. Median: $1,042 (110% 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	$82 - $2,131	9%
Amidacare	$102 - $947	11%
Emblem	$102 - $4,821	11%
Wellcare	$110 - $219	12%
Aetna	$111 - $2,177	12%
Fidelis	$147 - $2,131	15%
Oscar	$153 - $4,454	16%
Metroplus	$245 - $2,131	26%
Blue Cross Blue Shield	$947 - $2,131	100%
Carelon	$947 - $1,746	100%
Senior Whole Health	$947	100%
United	$947 - $2,829	100%
United Behavioral Health	$947 - $1,042	100%
Affinity	$966 - $2,131	102%
Carelon (Amida Care)	$966	102%
Vnsny	$966 - $1,079	102%
Elderplan	$1,079	114%
Vaccn	$1,079	114%
Centers Plan For Healthy Living	$1,122	118%
Centerlight	$1,343	141%
Magnacare	$2,014	212%
Multiplan	$2,149	226%
Villagecare Max	$2,283	240%
Local 1199	$2,334	246%
Oxford	$2,337 - $2,648	246%
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 $X.
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 Harlem 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.