CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Cambridge Health Alliance

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,646
Cash Discount Price: $3,230
vs. Medicare Baseline: 1.35x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Cambridge Health Alliance is $1,646. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,230. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.35x the Medicare baseline. Located in 1493 Cambridge Street, Cambridge, MA.

Cash / Self-Pay

$3,230

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,646

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: $3,230 (264%)

Insurance Median: $1,646 (135%)

Cash: $3,230 (264% of Medicare)

Ins. Median: $1,646 (135% 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
Mass Bh Partnership [70098]	$163	13%
Wc [90001]	$395	32%
Mass General Brigham [50021]	$1,047	86%
Wellpoint [50012]	$1,070	88%
Multiplan [50010]	$1,119	92%
Blue Cross Blue Shield	$1,120 - $1,646	92%
Other Tufts Health Public Plan [75002]	$1,140	93%
Aetna	$1,646	135%
Altus Dental [99011]	$1,646	135%
Beacon Health Strategies [50002]	$1,646	135%
Cbhc Uninsured Crisis Alt Payer [70097]	$1,646	135%
Cbhc Uninsured Crisis [70096]	$1,646	135%
Celticare [50004]	$1,646	135%
Cigna	$1,646	135%
Commonwealth Care Alliance Dental [99004]	$1,646	135%
Coverage Discovery [90004]	$1,646	135%
Delta Dental Of Ma [99007]	$1,646	135%
Dominion National Dental [99012]	$1,646	135%
Dph Tb Payor [85004]	$1,646	135%
Esp Dental [99003]	$1,646	135%
Eyemed Alt Payor [13001]	$1,646	135%
First Health [50007]	$1,646	135%
Global Medical Management [50024]	$1,646	135%
Government Employee Health Association [50023]	$1,646	135%
Guardian Dental [99013]	$1,646	135%
Health Safety Net Dental [99002]	$1,646	135%
Humana	$1,646	135%
Ma Laborers Health And Welfare Fund [50022]	$1,646	135%
Magellan Health Services [65098]	$1,646	135%
Mass Health Dental [99001]	$1,646	135%
Medical Mutual Of Ohio [50019]	$1,646	135%
Medicare (plans)	$1,646	135%
Metlife Dental [99008]	$1,646	135%
Modern Assistance Program [30098]	$1,646	135%
Mva [90002]	$1,646	135%
Neighborhood Health Plan [50011]	$1,646	135%
Other Bh Payor [50014]	$1,646	135%
Other Commercial Payor [50015]	$1,646	135%
Other Dental Payor [99014]	$1,646	135%
Other Dual Eligible Payer [65004]	$1,646	135%
Other Gov'T Alt [85006]	$1,646	135%
Other Vision Payor [50013]	$1,646	135%
Ri Neighborhood Health Plan [50017]	$1,646	135%
Tricare	$1,646	135%

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 $3,230.
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 Cambridge Health Alliance 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.