CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Boston Medical Center-Brighton

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,115
Cash Discount Price: $609
vs. Medicare Baseline: 1.17x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Boston Medical Center-Brighton is $1,115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $609. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.17x the Medicare baseline. Located in 736 Cambridge Street, Nevins Building, Brighton, MA.

Cash / Self-Pay

$609

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,115

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: $609 (64%)

Insurance Median: $1,115 (117%)

Cash: $609 (64% of Medicare)

Ins. Median: $1,115 (117% 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
Hsn Bad Debt [4003]	$475	50%
Hsn Confidential [4007]	$475	50%
Hsn Dental [4006]	$475	50%
Hsn Partial [4002]	$475	50%
Hsn [4001]	$475	50%
Harvard Pilgrim Health Care [8001]	$753	79%
Blue Cross Blue Shield	$852 - $1,115	90%
Aetna	$990 - $1,115	104%
Meritain Health [1023]	$990	104%
Unicare [8004]	$1,021	107%
Wellpoint [2034]	$1,021	107%
Mass General Brigham Health Plan Commercial [8009]	$1,025	108%
Mass General Brigham Health Plan Prime [7003]	$1,025	108%
Humana	$1,115	117%
Medicare (plans)	$1,115 - $1,170	117%
Neighborhood Pace [1206]	$1,115	117%
Senior Whole Health [1210]	$1,115	117%
Ubh Hphc [8016]	$1,115	117%
United Community Plan [1202]	$1,115	117%
UnitedHealthcare	$1,115	117%
Veterans Admin [9003]	$1,115	117%
Zzzcovid19 Hrsa Uninsured Testing And Treatment Fund [500010]	$1,115	117%
Cca [1215]	$1,170	123%
Zzzcca Onecare [1216]	$1,170	123%
Eternalhealth [1227]	$1,181	124%
Fallon [8008]	$1,449	153%
Cigna	$1,930 - $2,658	203%
Tufts [8002]	$1,930	203%

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 $609.
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 Boston Medical Center-Brighton 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.