CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Boston Children's Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,084
Cash Discount Price: $2,778
vs. Medicare Baseline: 1.70x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Boston Children's Hospital is $2,084. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,778. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.70x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$2,778

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,084

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: $2,778 (227%)

Insurance Median: $2,084 (170%)

Cash: $2,778 (227% of Medicare)

Ins. Median: $2,084 (170% 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
Cdphp	$1,361 - $2,361	111%
Harvard Pilgrim	$1,412 - $1,877	115%
Blue Cross Blue Shield	$1,567 - $1,834	128%
United	$1,662 - $2,321	136%
Aetna	$1,667 - $2,329	136%
Mgb/Allways	$1,689 - $2,054	138%
Tufts Public Plan	$1,707 - $1,710	140%
United Ri Nj Ny	$1,750	143%
Ambetter / Centene	$1,756	144%
Carelon Strategies/Bhs	$1,806	148%
UnitedHealthcare	$1,806 - $2,361	148%
Carelon/Beacon	$2,084	170%
Fallon	$2,120 - $2,142	173%
Health New England	$2,245	184%
Cigna	$2,361 - $2,507	193%
Ets/Lifetrac	$2,361	193%
Interlink Transplant	$2,361	193%
Community Health Options	$2,500	204%
Humana	$2,500	204%
Coventry/Hcvm/First Health	$2,556	209%
Multiplan/Phcs	$2,556 - $2,639	209%

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 $2,778.
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 Boston Children's 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.