CMS Price Transparency Data

Colonoscopy with biopsy

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 45380 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,410

about 1.2× the $1,223 Medicare rate · typically $570–$1,561

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,500

About the fair price

about $90 over the fair price · 1.2× Medicare

Medicare pays $1,223 Fair price $1,410 This hospital $1,500 Cash price $8,338 Hospital's list price $8,338

How we calculate the fair BaseRate →

How this hospital compares to other MA hospitals

Highest price of the 9 MA hospitals we have prices for — worth calling around.

Cheapest $395 Priciest $1,500

Black dot = this hospital, among the 9 MA hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Colonoscopy with biopsy is about $1,410 (about 1.2× the $1,223 Medicare rate). UMass Memorial Healthalliance Hospitals charges insurers about $1,500, or about $8,338 in cash — about the fair price. Located in Leominster, MA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna HumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$1,476 - $4,354	121%
Blue Cross Blue Shieldmajor	$1,120 - $1,523	92%
Aetnamajor	$1,506 - $2,848	123%
Cignamajor	$1,452 - $4,409	119%
Harvard Pilgrim	$980 - $1,524	80%
Tufts Health Plan	$753 - $2,470	62%
+ 12 smaller / regional plans	$294 - $4,354

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 8,338), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 45380.

Insurance Before you use insurance

Call your insurance company to confirm UMass Memorial Healthalliance Hospitals is in-network.
Ask your insurer whether prior approval is required for CPT code 45380.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at UMass Memorial Healthalliance Hospitals

Compare: Colonoscopy with biopsy at other MA hospitals

Metrowest Medical Center · Framingham $395
St Vincent Hospital · Worcester $395
North Adams Regional Hospital Corporation · North Adams $873
Cambridge Health Alliance · Cambridge $1,120
Newton-Wellesley Hospital · Newton $1,120
North Shore Medical Center - · Salem $1,246
Massachusetts General Hospital · Boston $1,246
Brigham and Women's Hospital · Boston $1,246

Insurance negotiated median for the same procedure, sorted lowest first.