CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Long Island Community Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 43239
  • Insurance Median: $1,464
  • Cash Discount Price: $190
  • vs. Medicare Baseline: 1.58x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Long Island Community Hospital is $1,464. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $190. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.58x the Medicare baseline. Located in 101 Hospital Road, Patchogue, NY.
Cash / Self-Pay
$190

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,464

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: $190 (21%)
Insurance Median: $1,464 (158%)
Cash: $190 (21% of Medicare)
Ins. Median: $1,464 (158% 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.

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
Local 1199 $432 47%
Magellan $561 61%
Multiplan $561 61%
Oscar Health Exchange $587 63%
Coventry $639 69%
Longevity Health $691 75%
Galaxy $777 84%
Aarp $864 93%
Aetna $864 - $6,906 93%
Beacon Health Options $864 93%
Blue Cross Blue Shield $864 - $3,309 93%
Centerlight $864 93%
Cigna $864 - $1,464 93%
Emblem Ghi $864 93%
Fidelis $864 93%
Humana $864 93%
Integra $864 93%
Medicare (plans) $864 93%
UnitedHealthcare $864 - $5,177 93%
Agewell $894 96%
Elderplan Inc. $950 103%
Wellcare $950 103%
Emblem $1,464 - $3,174 158%
Empire Mediblue $1,464 - $3,309 158%
Magnacare $1,464 - $9,174 158%
Nexus Nyu $1,464 - $4,542 158%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 101 Hospital Road, Patchogue, NY 11772
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals