CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Montefiore St Luke's Cornwall

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,254
Cash Discount Price: $1,161
vs. Medicare Baseline: 1.32x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Montefiore St Luke's Cornwall is $1,254. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,161. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.32x the Medicare baseline. Located in 70 Dubois Street, Newburgh, NY.

Cash / Self-Pay

$1,161

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,254

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: $1,161 (122%)

Insurance Median: $1,254 (132%)

Cash: $1,161 (122% of Medicare)

Ins. Median: $1,254 (132% 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	$530 - $1,335	56%
Affinity	$638 - $1,219	67%
Blue Cross Blue Shield	$638 - $3,713	67%
Emblem	$638 - $9,638	67%
Medicaid / KanCare	$638	67%
Hamaspik	$670 - $1,254	71%
Magnacare	$810 - $3,000	85%
Mediblue	$1,126	119%
Aetna	$1,149 - $3,470	121%
Cdphp	$1,161 - $2,811	122%
Fidelis	$1,161 - $1,347	122%
Hudson Valley	$1,161	122%
Oscar	$1,161 - $7,276	122%
Point Comfort	$1,161	122%
UnitedHealthcare	$1,161 - $4,457	122%
Villagecaremax	$1,161	122%
Vnsny Choice	$1,161	122%
Centerlight	$1,196	126%
Wellcare	$1,196	126%
Humana	$1,277	134%
Mvp	$1,647	173%
Geha	$2,086 - $3,470	220%
Meritain Health	$2,086 - $3,470	220%
Nippon Life Insurance	$2,086 - $3,470	220%
Northwell	$3,123	329%
American Postal Workers	$4,457	469%
Seiu1199	$5,826	613%

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 $1,161.
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 Montefiore St Luke's Cornwall 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.