CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Fairview Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $1,730
Cash Discount Price: $2,540
vs. Medicare Baseline: 1.82x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Fairview Hospital is $1,730. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,540. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 1.82x the Medicare baseline. Located in 29 Lewis Avenue, Great Barrington, MA.

Cash / Self-Pay

$2,540

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,730

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: $2,540 (267%)

Insurance Median: $1,730 (182%)

Cash: $2,540 (267% of Medicare)

Ins. Median: $1,730 (182% 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
Comm Fallon Qhp	$270 - $1,647	28%
Other Government	$339 - $1,043	36%
Medicare (plans)	$384 - $1,026	40%
Hospice	$391 - $1,043	41%
UnitedHealthcare	$391 - $2,299	41%
Health New England	$396 - $3,214	42%
Fallon	$404 - $1,176	43%
Workers Comp	$424 - $1,704	45%
Blue Cross Blue Shield	$442 - $2,273	47%
Commcare Alliance	$461 - $1,022	49%
Comm Hne Hmo	$640 - $1,844	67%
Unicare	$671 - $1,734	71%
Comm Hne Ppo	$680 - $1,959	72%
Point32Health	$1,511 - $2,540	159%
Allways Nhp	$1,730	182%
Aetna	$2,019	213%
Capital District Physicians' Health Plan	$2,406	253%
Cigna	$2,406 - $2,486	253%
Mvp	$2,406	253%
Oxford	$2,406	253%
First Health	$2,486 - $2,540	262%
Connecticare	$2,540	267%
Consolidated Health Plans	$2,540	267%
Other Commercial	$2,540	267%
Phcs	$2,540	267%
Self Pay	$2,540	267%
Medicaid / KanCare	$3,214	338%
Bmchnp	$3,342	352%

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 $2,540.
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 Fairview 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.