CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Albany Medical Center Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $340
Cash Discount Price: $254
vs. Medicare Baseline: 0.36x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Albany Medical Center Hospital is $340. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $254. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.36x the Medicare baseline. Located in 43 New Scotland Avenue, Mail Code 34, Albany, NY.

Cash / Self-Pay

$254

Average discount available for prompt cash payment at this facility.

Insurance Median

$340

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: $254 (27%)

Insurance Median: $340 (36%)

Cash: $254 (27% of Medicare)

Ins. Median: $340 (36% 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
Aetna	$94 - $5,476	10%
Medicaid / KanCare	$103 - $315	11%
Cdphp	$116 - $5,076	12%
Medicare (plans)	$128 - $358	13%
Fidelis	$134 - $2,087	14%
Blue Cross Blue Shield	$141 - $3,466	15%
Tricare	$145 - $313	15%
Hamaspik	$159 - $2,180	17%
Blue Shield Highmark	$160 - $654	17%
Mvp	$167 - $1,025	18%
UnitedHealthcare	$171 - $2,227	18%
Nascentia	$188 - $345	20%
Emblem Health Ghi	$189 - $680	20%
Nascentia Health Options	$247	26%
Emblem	$254 - $5,696	27%
Cigna	$260 - $553	27%
Magnacare	$280 - $2,227	29%
Multiplan	$297 - $2,366	31%
Mvp Commercial	$325 - $4,563	34%
Empire Plan Nyship	$346 - $3,466	36%
Nys Department Of Corrections	$411 - $698	43%
Blue Shield	$433 - $5,093	46%
Mvp Essential Plan	$1,994	210%
Emblem_Ghi	$7,595	799%

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 $254.
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 Albany Medical Center 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.