CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Saratoga Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $341
Cash Discount Price: $499
vs. Medicare Baseline: 0.37x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Saratoga Hospital is $341. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $499. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.37x the Medicare baseline. Located in 211 Church Street, Saratoga Springs, NY.

Cash / Self-Pay

$499

Average discount available for prompt cash payment at this facility.

Insurance Median

$341

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: $499 (54%)

Insurance Median: $341 (37%)

Cash: $499 (54% of Medicare)

Ins. Median: $341 (37% 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
Cdphp	$87 - $4,172	9%
Fidelis	$96 - $2,177	10%
Medicare (plans)	$96 - $341	10%
Medicaid / KanCare	$101 - $355	11%
Blue Cross Blue Shield	$103 - $1,810	11%
Tricare	$109 - $341	12%
Hamaspik	$119 - $2,274	13%
Mvp	$125 - $623	13%
Emblem Health Ghi	$128 - $375	14%
UnitedHealthcare	$128 - $2,327	14%
Aetna	$130 - $3,020	14%
Blue Shield Highmark	$141 - $492	15%
Nascentia Health Options	$185	20%
Emblem	$190 - $1,553	21%
Cigna	$194 - $623	21%
Empire Plan Nyship	$624 - $1,810	67%
Mvp Commercial	$624 - $4,445	67%
Multiplan	$669 - $2,198	72%
Magnacare	$803 - $2,457	87%
Mvp Essential Plan	$968 - $1,935	104%
Mvp Govt Programs	$968	104%
Blue Shield	$1,744 - $4,443	188%

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 $499.
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 Saratoga 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.