CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Jones Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $329
Cash Discount Price: $1,782
vs. Medicare Baseline: 0.36x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Jones Memorial Hospital is $329. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,782. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.36x the Medicare baseline. Located in 191 North Main Street, Wellsville, NY.

Cash / Self-Pay

$1,782

Average discount available for prompt cash payment at this facility.

Insurance Median

$329

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: $1,782 (192%)

Insurance Median: $329 (36%)

Cash: $1,782 (192% of Medicare)

Ins. Median: $329 (36% 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
Medicaid / KanCare	$84 - $376	9%
Aetna	$112 - $1,285	12%
Excellus 2201	$112 - $708	12%
Medicare (plans)	$119 - $1,803	13%
Blue Cross Blue Shield	$121 - $2,365	13%
UnitedHealthcare	$124 - $1,213	13%
Cigna	$166 - $2,965	18%
Independent Health 5156	$174 - $1,803	19%
Fidelis 5155	$177 - $484	19%
Capital District Physicians Health Plan (Cdphp) 5149	$335 - $926	36%
UPMC Health Plan 5138	$909	98%
Humana	$1,213	131%
Total Senior Care 1319	$1,213	131%
Empire Plan 5179	$2,146	232%
Mvp 2900	$2,862	309%

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 $1,782.
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 Jones Memorial 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.