CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Albany Medical Center Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $406
Cash Discount Price: $490
vs. Medicare Baseline: 0.33x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Albany Medical Center Hospital is $406. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $490. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.33x the Medicare baseline. Located in 43 New Scotland Avenue, Mail Code 34, Albany, NY.

Cash / Self-Pay

$490

Average discount available for prompt cash payment at this facility.

Insurance Median

$406

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: $490 (40%)

Insurance Median: $406 (33%)

Cash: $490 (40% of Medicare)

Ins. Median: $406 (33% 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
Cdphp	$126 - $5,076	10%
Medicare (plans)	$139 - $454	11%
Fidelis	$146 - $2,386	12%
Blue Cross Blue Shield	$153 - $4,463	13%
Tricare	$158 - $396	13%
Medicaid / KanCare	$162 - $405	13%
Hamaspik	$173 - $2,180	14%
Blue Shield Highmark	$174 - $842	14%
Mvp	$181 - $1,326	15%
UnitedHealthcare	$186 - $2,227	15%
Aetna	$193 - $5,476	16%
Nascentia	$204 - $436	17%
Emblem Health Ghi	$206 - $860	17%
Nascentia Health Options	$269	22%
Emblem	$277 - $5,696	23%
Cigna	$282 - $712	23%
Magnacare	$364 - $2,227	30%
Multiplan	$387 - $2,366	32%
Nys Department Of Corrections	$447 - $897	37%
Blue Shield	$984 - $5,093	80%
Mvp Essential Plan	$1,994	163%
Mvp Commercial	$3,470 - $4,563	284%
Empire Plan Nyship	$4,463	365%
Emblem_Ghi	$7,595	621%

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 $490.
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 Albany Medical Center Hospital 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.