CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Montefiore St Luke's Cornwall

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,500
Cash Discount Price: $1,494
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Montefiore St Luke's Cornwall is $1,500. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,494. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.23x the Medicare baseline. Located in 70 Dubois Street, Newburgh, NY.

Cash / Self-Pay

$1,494

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,500

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: $1,494 (122%)

Insurance Median: $1,500 (123%)

Cash: $1,494 (122% of Medicare)

Ins. Median: $1,500 (123% 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	$530 - $1,494	43%
Affinity	$638 - $1,568	52%
Blue Cross Blue Shield	$638 - $5,240	52%
Emblem	$638 - $9,638	52%
Medicaid / KanCare	$638	52%
Hamaspik	$670 - $1,613	55%
Magnacare	$810 - $3,000	66%
Mediblue	$1,449	119%
Aetna	$1,479 - $3,470	121%
Cdphp	$1,494 - $2,811	122%
Fidelis	$1,494 - $1,733	122%
Hudson Valley	$1,494	122%
Oscar	$1,494 - $7,276	122%
Point Comfort	$1,494	122%
UnitedHealthcare	$1,494 - $4,457	122%
Villagecaremax	$1,494	122%
Vnsny Choice	$1,494	122%
Centerlight	$1,539	126%
Wellcare	$1,539	126%
Humana	$1,643	134%
Mvp	$1,647	135%
Geha	$2,086 - $3,470	171%
Meritain Health	$2,086 - $3,470	171%
Nippon Life Insurance	$2,086 - $3,470	171%
Northwell	$4,018	329%
American Postal Workers	$4,457	365%
Seiu1199	$5,826	477%

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 $1,494.
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 Montefiore St Luke's Cornwall 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.