CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,170
Cash Discount Price: $6,062
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at UMass Memorial Healthalliance Hospitals is $1,170. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,062. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.23x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$6,062

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,170

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$950.1

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $950.1 (100%)

Cash / Self-Pay: $6,062 (638%)

Insurance Median: $1,170 (123%)

Cash: $6,062 (638% of Medicare)

Ins. Median: $1,170 (123% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $950.1 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
Hsno/Free Care [10801]	$294	31%
Workers Compensation [20501]	$395 - $1,431	42%
Blue Cross Blue Shield	$426 - $1,166	45%
Fallon Connectorcare [10503]	$506 - $3,132	53%
Tufts Mcr [10112]	$585 - $1,185	62%
Harvard Pilgrim [10701]	$745	78%
Champva [11001]	$974	103%
Institution [10406]	$1,115 - $2,308	117%
Tufts Dual [10111]	$1,115 - $1,128	117%
Cigna	$1,128 - $4,409	119%
Correctional Care [11003]	$1,128	119%
Medicaid / KanCare	$1,128 - $2,264	119%
Medicare (plans)	$1,128	119%
Tufts Us Family [11203]	$1,128	119%
Aetna	$1,170 - $2,848	123%
Commonwealth Care Mcr [10115]	$1,170 - $1,185	123%
Fallon Mcr Supp [20202]	$1,170 - $1,185	123%
Mgb Mcr [10124]	$1,170 - $1,185	123%
Harvard Pilgrim Mcr [10106]	$1,185	125%
UnitedHealthcare	$1,185 - $4,354	125%
Senior Whole Health [10110]	$1,207	127%
Tufts [11201]	$1,509	159%
Wellpoint [11112]	$1,523	160%
Tufts Connectorcare [10507]	$1,896 - $1,919	200%
Hne [11108]	$2,429	256%
First Health Network [11120]	$3,266	344%
Multiplan [11109]	$3,266	344%
Connecticare [11105]	$4,354	458%
Fallon Carelon Hlth [28]	$4,354	458%
Fallon Mcaid Carelon Hlth [29]	$4,354	458%
Grants [20507]	$4,354	458%

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 $6,062.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UMass Memorial Healthalliance Hospitals is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45378.
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.