CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Univ. of Vermont - Fletcher Allen Health Care

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,415
Cash Discount Price: $4,918
vs. Medicare Baseline: 1.16x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Univ. of Vermont - Fletcher Allen Health Care is $1,415. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,918. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.16x the Medicare baseline. Located in 111 Colchester Ave, Burlington, VT.

Cash / Self-Pay

$4,918

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,415

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: $4,918 (402%)

Insurance Median: $1,415 (116%)

Cash: $4,918 (402% of Medicare)

Ins. Median: $1,415 (116% 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
Mvp	$157 - $3,504	13%
Aetna	$185 - $1,188	15%
Humana	$185 - $1,377	15%
St. Regis	$185 - $1,188	15%
Veterans Affairs Community Care Network	$185 - $1,188	15%
Blue Cross Blue Shield	$189 - $4,762	15%
Fidelis Care	$213 - $1,307	17%
Wellpath	$259 - $2,705	21%
UnitedHealthcare	$277 - $4,841	23%
Capital District Physicians' Health Plan	$405 - $3,684	33%
Martins Point	$405 - $1,218	33%
Ebpa	$1,388 - $4,229	114%
Harvard Pilgrim	$1,442 - $3,934	118%
Magnacare	$1,442 - $3,934	118%
Coventry	$1,532 - $4,180	125%
Cigna	$1,592 - $4,426	130%
Nppn	$1,622 - $4,426	133%

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 $4,918.
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 Univ. of Vermont - Fletcher Allen Health Care 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.