CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Guthrie Cortland Regional Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,109
Cash Discount Price: $4,969
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Guthrie Cortland Regional Medical Center is $1,109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,969. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.20x the Medicare baseline. Located in 134 Homer Avenue, Cortland, NY.

Cash / Self-Pay

$4,969

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,109

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: $4,969 (536%)

Insurance Median: $1,109 (120%)

Cash: $4,969 (536% of Medicare)

Ins. Median: $1,109 (120% 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
Amerihealth	$193 - $1,224	21%
Geisinger	$195 - $1,109	21%
Blue Cross Blue Shield	$366 - $6,211	39%
Health Partners	$728 - $1,030	79%
Fidelis	$823 - $6,211	89%
Humana	$871 - $1,109	94%
UnitedHealthcare	$880 - $5,155	95%
Wellcare	$886 - $6,211	96%
Tricare	$909 - $1,109	98%
Cdphp	$948 - $6,211	102%
Freedom Blue	$948	102%
Aetna	$987 - $1,109	107%
Mvp	$1,061 - $6,211	115%
Icircle	$1,109 - $6,211	120%
Upmc	$1,109	120%
Emblem	$1,248 - $4,969	135%
Fidelis Essential	$1,851 - $6,211	200%

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 $4,969.
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 Guthrie Cortland Regional Medical Center 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.