CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Massachusetts General Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,400
Cash Discount Price: $1,966
vs. Medicare Baseline: 1.15x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Massachusetts General Hospital is $1,400. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,966. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.15x the Medicare baseline. Located in 55 Fruit Street, Boston, MA.

Cash / Self-Pay

$1,966

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,400

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: $1,966 (161%)

Insurance Median: $1,400 (115%)

Cash: $1,966 (161% of Medicare)

Ins. Median: $1,400 (115% 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
Mgb Health Plan [150001]	$813 - $1,400	66%
Harvard Pilgrim Alternate [120002]	$980	80%
Harvard Pilgrim [120001]	$980	80%
UnitedHealthcare	$980 - $2,142	80%
Blue Cross Blue Shield	$1,120 - $1,400	92%
Tricare	$1,330	109%
Tufts Health Plan [170001]	$1,372	112%
Cigna	$1,397 - $2,084	114%
Commonwealth Care Alliance [1007]	$1,400	115%
Elder Services [1037]	$1,400	115%
Humana	$1,400	115%
Martin'S Point [160007]	$1,400	115%
Medicare (plans)	$1,400	115%
Aetna	$1,442 - $2,107	118%
Centers Of Excellence [1026]	$1,835	150%
Phcs Multiplan [1022]	$2,018	165%
International Commercial [140001]	$2,084 - $2,107	170%

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 $1,966.
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 Massachusetts General Hospital 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.