CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Boston Medical Center-Brighton

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,434
Cash Discount Price: $788
vs. Medicare Baseline: 1.17x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Boston Medical Center-Brighton is $1,434. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $788. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.17x the Medicare baseline. Located in 736 Cambridge Street, Nevins Building, Brighton, MA.

Cash / Self-Pay

$788

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,434

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: $788 (64%)

Insurance Median: $1,434 (117%)

Cash: $788 (64% of Medicare)

Ins. Median: $1,434 (117% 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
Hsn Bad Debt [4003]	$475	39%
Hsn Confidential [4007]	$475	39%
Hsn Dental [4006]	$475	39%
Hsn Partial [4002]	$475	39%
Hsn [4001]	$475	39%
Harvard Pilgrim Health Care [8001]	$753	62%
Unicare [8004]	$1,021	84%
Wellpoint [2034]	$1,021	84%
Blue Cross Blue Shield	$1,120 - $1,434	92%
Aetna	$1,281 - $1,434	105%
Meritain Health [1023]	$1,281	105%
Mass General Brigham Health Plan Commercial [8009]	$1,326	108%
Mass General Brigham Health Plan Prime [7003]	$1,326	108%
Humana	$1,434	117%
Medicare (plans)	$1,434 - $1,506	117%
Neighborhood Pace [1206]	$1,434	117%
Senior Whole Health [1210]	$1,434	117%
Ubh Hphc [8016]	$1,434	117%
United Community Plan [1202]	$1,434	117%
UnitedHealthcare	$1,434	117%
Veterans Admin [9003]	$1,434	117%
Zzzcovid19 Hrsa Uninsured Testing And Treatment Fund [500010]	$1,434	117%
Cca [1215]	$1,506	123%
Zzzcca Onecare [1216]	$1,506	123%
Eternalhealth [1227]	$1,520	124%
Fallon [8008]	$1,864	152%
Cigna	$1,930	158%
Tufts [8002]	$1,930	158%

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 $788.
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 Medical Center-Brighton 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.