CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Emerson Hospital -

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,459
Cash Discount Price: $1,745
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Emerson Hospital - is $1,459. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,745. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.54x the Medicare baseline. Located in 133 Old Road To 9 Acre Corner, W Concord, MA.

Cash / Self-Pay

$1,745

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,459

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: $1,745 (184%)

Insurance Median: $1,459 (154%)

Cash: $1,745 (184% of Medicare)

Ins. Median: $1,459 (154% 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
Medicare (plans)	$1,092 - $1,119	115%
Tufts Senior Care Options	$1,092	115%
Blue Cross Blue Shield	$1,097 - $1,222	115%
UnitedHealthcare	$1,097 - $2,326	115%
Wellpoint (Formerly Unicare)	$1,104	116%
Medicaid / KanCare	$1,115	117%
Masshealth	$1,697	179%
Mgb Mh Aco	$1,697	179%
Tufts Ppo	$1,723	181%
Cigna	$2,128	224%
Aetna	$2,401	253%

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 $1,745.
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 Emerson 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.