CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Boston Children's Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,460
Cash Discount Price: $1,947
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Boston Children's Hospital is $1,460. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,947. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.54x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$1,947

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,460

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: $1,947 (205%)

Insurance Median: $1,460 (154%)

Cash: $1,947 (205% of Medicare)

Ins. Median: $1,460 (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
Cdphp	$954 - $1,655	100%
Harvard Pilgrim	$990 - $1,316	104%
Blue Cross Blue Shield	$1,098 - $1,285	116%
United	$1,164 - $1,627	123%
Aetna	$1,168 - $1,632	123%
Mgb/Allways	$1,184 - $1,439	125%
Tufts Public Plan	$1,196 - $1,199	126%
United Ri Nj Ny	$1,227	129%
Ambetter / Centene	$1,230	129%
Carelon Strategies/Bhs	$1,266	133%
UnitedHealthcare	$1,266 - $1,655	133%
Carelon/Beacon	$1,460	154%
Fallon	$1,486 - $1,501	156%
Health New England	$1,573	166%
Cigna	$1,655 - $1,757	174%
Ets/Lifetrac	$1,655	174%
Interlink Transplant	$1,655	174%
Community Health Options	$1,752	184%
Humana	$1,752	184%
Coventry/Hcvm/First Health	$1,791	189%
Multiplan/Phcs	$1,791 - $1,850	189%

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 $1,947.
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 Children's 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.