CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Albany Medical Center Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $103
Cash Discount Price: $107
vs. Medicare Baseline: 1.08x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Albany Medical Center Hospital is $103. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $107. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.08x the Medicare baseline. Located in 43 New Scotland Avenue, Mail Code 34, Albany, NY.

Cash / Self-Pay

$107

Average discount available for prompt cash payment at this facility.

Insurance Median

$103

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $107 (112%)

Insurance Median: $103 (108%)

Cash: $107 (112% of Medicare)

Ins. Median: $103 (108% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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
Medicaid / KanCare	$21 - $80	22%
Cdphp	$24 - $150	25%
Aetna	$31 - $177	33%
Carelon Beacon Behavioral	$37 - $99	39%
Medicare (plans)	$46 - $96	48%
Mvp	$46 - $125	48%
Fidelis	$49 - $194	51%
Blue Cross Blue Shield	$51 - $136	54%
Blue Shield	$51 - $178	54%
Tricare	$53 - $86	56%
Hamaspik	$58 - $107	61%
Blue Shield Highmark	$62 - $148	65%
UnitedHealthcare	$62 - $258	65%
Nascentia	$68 - $94	71%
Emblem Health Ghi	$69 - $186	72%
Cigna	$71 - $125	75%
Emblem	$88 - $258	92%
Mvp Commercial	$90 - $242	95%
Nascentia Health Options	$92 - $140	97%
Emblem_Ghi	$96 - $258	101%
Empire Plan Nyship	$96 - $258	101%
Magnacare	$96 - $258	101%
Multiplan	$102 - $275	107%
Nys Department Of Corrections	$111 - $161	117%
Mvp Essential Plan	$258 - $694	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 $107.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

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 99213.
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.