CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Berkshire Medical Center

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,108
Cash Discount Price: $3,310
vs. Medicare Baseline: 1.72x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Berkshire Medical Center is $2,108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,310. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.72x the Medicare baseline. Located in 725 North Street, Pittsfield, MA.

Cash / Self-Pay

$3,310

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,108

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: $3,310 (271%)

Insurance Median: $2,108 (172%)

Cash: $3,310 (271% of Medicare)

Ins. Median: $2,108 (172% 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
Fallon	$214 - $1,814	18%
Other Government	$431 - $1,536	35%
Medicare (plans)	$490 - $1,511	40%
Hospice	$498 - $1,536	41%
UnitedHealthcare	$498 - $2,996	41%
Health New England	$504 - $2,543	41%
Workers Comp	$506 - $2,113	41%
Blue Cross Blue Shield	$514 - $2,961	42%
Commcare Alliance	$514 - $1,814	42%
Comm Hne Hmo	$822 - $2,403	67%
Unicare	$867 - $2,259	71%
Comm Hne Ppo	$873 - $2,553	71%
Cdphp	$1,589 - $3,135	130%
Mbhp	$1,589	130%
Mcd Out Of State	$1,589	130%
Medicaid / KanCare	$1,589	130%
Comm Tufts Qhpsub (Network)	$1,968 - $2,108	161%
Point32Health	$1,968 - $3,310	161%
Bmchnp	$2,066	169%
Allways Nhp	$2,254	184%
Aetna	$2,630	215%
Beacon	$2,961 - $3,135	242%
Cigna	$3,135 - $3,240	256%
Mvp	$3,135	256%
Oxford	$3,135	256%
First Health	$3,240 - $3,310	265%
Connecticare	$3,310	271%
Consolidated Health Plans	$3,310	271%
Other Commercial	$3,310	271%
Phcs	$3,310	271%
Self Pay	$3,310	271%

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 $3,310.
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 Berkshire Medical Center 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.