CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: St Catherine of Siena Hospital
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $1,220
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.32x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at St Catherine of Siena Hospital is $1,220. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.32x the Medicare baseline. Located in 50 Route 25A, Smithtown, NY.
Cash / Self-Pay
Unavailable
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,220
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%)
Insurance Median: $1,220 (132%)
Ins. Median: $1,220 (132% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Zadroga | $286 | 31% |
| Affinity Health Plan | $1,040 - $2,341 | 112% |
| Beacon Health Options | $1,040 - $1,553 | 112% |
| Beacon Health Strategies | $1,040 - $1,553 | 112% |
| Centerlight Healthcare | $1,040 - $1,109 | 112% |
| Elderplan Inc. | $1,040 - $1,109 | 112% |
| Emblem Health | $1,040 - $3,902 | 112% |
| Fidelis Care New York | $1,040 - $2,341 | 112% |
| Health First | $1,040 - $2,496 | 112% |
| Health Plus | $1,040 - $2,341 | 112% |
| Independent Health | $1,040 - $1,109 | 112% |
| Medicaid / KanCare | $1,040 | 112% |
| Mvp Health Plans | $1,040 - $3,670 | 112% |
| Senior Whole Health | $1,040 - $1,109 | 112% |
| UnitedHealthcare | $1,040 - $3,612 | 112% |
| Blue Cross Blue Shield | $1,087 - $3,488 | 117% |
| Aetna | $1,109 - $4,197 | 120% |
| Centers Plan For Healthy Living | $1,109 | 120% |
| Healthspring | $1,109 | 120% |
| Liberty Health | $1,109 | 120% |
| Longevity Health Plan | $1,109 | 120% |
| Medicare (plans) | $1,109 - $1,165 | 120% |
| Orthonet - Uniformed Services Family Health Plan | $1,109 | 120% |
| Pmc | $1,109 | 120% |
| Tricare | $1,109 | 120% |
| Universal Healthcare | $1,109 | 120% |
| Us Family Health Plan | $1,109 | 120% |
| Veterans Affairs | $1,109 | 120% |
| Humana | $1,132 | 122% |
| Agewell New York | $1,148 | 124% |
| Partners Health Plan | $1,165 | 126% |
| Brighton | $1,200 - $3,547 | 130% |
| Wellcare Health Plan Inc | $1,220 | 132% |
| Oscar Health | $1,408 | 152% |
| Allied Wellfare Fund | $2,233 | 241% |
| American Group Administrators | $2,233 | 241% |
| Bakery & Confectionery Union | $2,233 | 241% |
| Cigna | $2,233 - $3,670 | 241% |
| Comprehensive Benefits Consultant | $2,233 | 241% |
| Guardian Life Insurance Company Of America | $2,233 | 241% |
| Maloney And Assoc | $2,233 | 241% |
| Multiplan | $2,233 | 241% |
| Performax | $2,233 | 241% |
| Phcs | $2,233 | 241% |
| Pomco | $2,233 | 241% |
| Tpa Inc | $2,233 | 241% |
| Unicare | $2,233 | 241% |
| United Employees Health Plan | $2,233 | 241% |
| Coventry | $2,542 - $2,748 | 274% |
| Magellan | $2,748 | 297% |
| Galaxy | $3,092 | 334% |
| Three Rivers Provider Network | $3,092 | 334% |
| Centivo | $3,398 - $3,670 | 367% |
| Aither Health | $3,435 | 371% |
| Alpha Care | $3,435 | 371% |
| Dentaquest | $3,435 | 371% |
| Self Pay | $3,488 | 376% |
| Surest | $3,612 | 390% |
| Apwu | $3,670 | 396% |
| Daniel H Cook | $3,670 | 396% |
| Nalc | $3,670 | 396% |
| Samba | $3,670 | 396% |
| American Plan Administrators | $3,902 | 421% |
| Amerihealth Administrators | $3,902 | 421% |
| Benefit Services | $3,902 | 421% |
| Ghi Cbp Ny City Employee Alternate | $3,902 | 421% |
| International Benefit Administrator | $3,902 | 421% |
| Ultra Benefits Inc. | $3,902 | 421% |
| Local 1199 | $3,945 | 426% |
| Mail Handlers Benefit Plan | $4,197 | 453% |
| Meritain Health | $4,197 | 453% |
| Nippon Life Insurance Company Of America | $4,197 | 453% |
| Salvation Army | $4,197 | 453% |