CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Geneva General Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $145
Cash Discount Price: $524
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Geneva General Hospital is $145. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $524. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.16x the Medicare baseline. Located in 196 -198 North Street, Geneva, NY.

Cash / Self-Pay

$524

Average discount available for prompt cash payment at this facility.

Insurance Median

$145

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$926.63

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $926.63 (100%)

Cash / Self-Pay: $524 (57%)

Insurance Median: $145 (16%)

Cash: $524 (57% of Medicare)

Ins. Median: $145 (16% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $926.63 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	$101 - $1,109	11%
Excellus Blue Choice Options	$101	11%
Fidelis	$101 - $1,220	11%
Mvp Health Care	$101 - $2,010	11%
UnitedHealthcare	$101 - $1,109	11%
Blue Cross Blue Shield	$131 - $1,724	14%
Emblem Group Health Incorporated	$131 - $1,114	14%
Excellus Blue Choice	$131 - $1,003	14%
Wellcare	$138 - $1,109	15%

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 $524.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 43239.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Geneva General Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 43239.
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.