CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Elizabethtown Community Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $797
Cash Discount Price: $2,188
vs. Medicare Baseline: 0.86x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Elizabethtown Community Hospital is $797. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,188. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.86x the Medicare baseline. Located in 75 Park Street, Elizabethtown, NY.

Cash / Self-Pay

$2,188

Average discount available for prompt cash payment at this facility.

Insurance Median

$797

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: $2,188 (236%)

Insurance Median: $797 (86%)

Cash: $2,188 (236% of Medicare)

Ins. Median: $797 (86% 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
Fidelis Care	$109 - $1,261	12%
Mvp	$109 - $2,592	12%
Humana	$121 - $891	13%
Aetna	$128 - $2,488	14%
Blue Cross Blue Shield	$128 - $2,494	14%
Veterans Affairs Community Care Network	$128 - $1,261	14%
Choicecare	$141 - $2,654	15%
Wellpath	$179 - $1,891	19%
UnitedHealthcare	$228 - $3,056	25%
Capital District Physicians' Health Plan	$232 - $1,261	25%
Martins Point	$341 - $1,261	37%
Highmark Blueshield	$477 - $2,704	51%
Harvard Pilgrim	$846 - $2,654	91%
Magnacare	$846 - $2,654	91%
Coventry	$898 - $2,820	97%
Multiplan	$951 - $2,986	103%
Emblem Health	$2,654	286%

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 $2,188.
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 Elizabethtown Community 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.