CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,166
Cash Discount Price: $7,014
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at UMass Memorial Health - Harrington Hospital is $1,166. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,014. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.23x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$7,014

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,166

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: $7,014 (738%)

Insurance Median: $1,166 (123%)

Cash: $7,014 (738% of Medicare)

Ins. Median: $1,166 (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
Medicaid / KanCare	$56 - $1,540	6%
Blue Cross Blue Shield	$426 - $1,166	45%
Fallon Connectorcare [10503]	$506 - $2,130	53%
Tufts Mcr [10112]	$585 - $1,185	62%
Hsno/Free Care [10801]	$681	72%
Harvard Pilgrim [10701]	$753	79%
Cigna	$1,052 - $2,105	111%
Tufts [11201]	$1,052 - $2,105	111%
Champva [11001]	$1,083	114%
Institution [10406]	$1,115 - $1,128	117%
Mgb Mcr [10124]	$1,115 - $1,128	117%
Tufts Us Family [11203]	$1,128	119%
Aetna	$1,170 - $2,961	123%
Commonwealth Care Alliance [10103]	$1,170 - $1,185	123%
Fallon Mcr Supp [20202]	$1,170 - $1,185	123%
Fallon Mcr [10105]	$1,170 - $1,185	123%
UnitedHealthcare	$1,185 - $2,961	125%
Senior Whole Health [10110]	$1,207	127%
Workers Compensation [20501]	$1,444	152%
Wellpoint [11112]	$1,523	160%
Tufts Connectorcare [10507]	$1,896 - $1,919	200%
Hne [11108]	$1,927	203%
First Health Network [11120]	$2,221	234%
Evernorth Behavioral Health [27]	$2,369	249%
Connecticare [11105]	$2,961	312%
Fallon Carelon Hlth [28]	$2,961	312%
Fallon Mcaid Carelon Hlth [29]	$2,961	312%
Grants [20507]	$2,961	312%
Masshealth Mcd Mbhp [38]	$2,961	312%
Wellsense Mcaid Carelon Hlth [21]	$2,961	312%

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 $7,014.
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 Health - Harrington Hospital 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.