CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Harlem Hospital Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,412
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.15x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Harlem Hospital Center is $1,412. 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 $1,222.56, this hospital’s rate is 1.15x 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

$1,412

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%)

Insurance Median: $1,412 (115%)

Ins. Median: $1,412 (115% 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	$176 - $2,131	14%
Wellcare	$238 - $2,118	19%
Aetna	$240 - $2,177	20%
Local 1199	$274 - $3,001	22%
Fidelis	$318 - $2,131	26%
Emblem	$319 - $4,821	26%
Magnacare	$320 - $2,648	26%
Oxford	$362 - $2,648	30%
United	$434 - $2,829	35%
Oscar	$614 - $4,454	50%
Metroplus	$864 - $2,131	71%
Amidacare	$947	77%
Blue Cross Blue Shield	$947 - $2,825	77%
Carelon	$947 - $2,295	77%
Senior Whole Health	$947	77%
United Behavioral Health	$947 - $1,042	77%
Affinity	$966 - $2,131	79%
Carelon (Amida Care)	$966	79%
Vnsny	$966 - $3,001	79%
Elderplan	$1,395 - $2,295	114%
Vaccn	$1,395	114%
Centers Plan For Healthy Living	$1,451	119%
Centerlight	$1,765	144%
Multiplan	$2,825	231%
Villagecare Max	$3,001	245%
Cigna	$4,285	350%

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: 45380.

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 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.