CMS Price Transparency Data

Colonoscopy with biopsy

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,506
Cash Discount Price: $8,338
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at UMass Memorial Healthalliance Hospitals is $1,506. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,338. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.23x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$8,338

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,506

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: $8,338 (682%)

Insurance Median: $1,506 (123%)

Cash: $8,338 (682% of Medicare)

Ins. Median: $1,506 (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
Medicaid / KanCare	$56 - $2,264	5%
Hsno/Free Care [10801]	$294	24%
Workers Compensation [20501]	$395 - $1,431	32%
Fallon Connectorcare [10503]	$506 - $3,132	41%
Tufts Mcr [10112]	$753 - $1,524	62%
Harvard Pilgrim [10701]	$980	80%
Blue Cross Blue Shield	$1,120 - $1,500	92%
Champva [11001]	$1,260	103%
Institution [10406]	$1,434 - $2,308	117%
Medicare (plans)	$1,434 - $1,452	117%
Tufts Dual [10111]	$1,434 - $1,452	117%
Cigna	$1,452 - $4,409	119%
Correctional Care [11003]	$1,452	119%
Tufts Us Family [11203]	$1,452	119%
UnitedHealthcare	$1,476 - $4,354	121%
Aetna	$1,506 - $2,848	123%
Commonwealth Care Mcr [10115]	$1,506 - $1,524	123%
Fallon Mcr Supp [20202]	$1,506 - $1,524	123%
Mgb Mcr [10124]	$1,506 - $1,524	123%
Tufts [11201]	$1,509	123%
Wellpoint [11112]	$1,523	125%
Harvard Pilgrim Mcr [10106]	$1,524	125%
Senior Whole Health [10110]	$1,553	127%
Hne [11108]	$2,429	199%
Tufts Connectorcare [10507]	$2,439 - $2,470	199%
First Health Network [11120]	$3,266	267%
Multiplan [11109]	$3,266	267%
Connecticare [11105]	$4,354	356%
Fallon Carelon Hlth [28]	$4,354	356%
Fallon Mcaid Carelon Hlth [29]	$4,354	356%
Grants [20507]	$4,354	356%

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 $8,338.
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 UMass Memorial Healthalliance 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.