CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: The University of Vermont Health Network-Alice Hy

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $496
Cash Discount Price: $3,101
vs. Medicare Baseline: 0.54x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at The University of Vermont Health Network-Alice Hy is $496. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,101. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.54x the Medicare baseline. Located in 133 Park Street, Po Box 729, Malone, NY.

Cash / Self-Pay

$3,101

Average discount available for prompt cash payment at this facility.

Insurance Median

$496

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: $3,101 (335%)

Insurance Median: $496 (54%)

Cash: $3,101 (335% of Medicare)

Ins. Median: $496 (54% 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 - $1,191	12%
Humana	$109 - $1,191	12%
Mvp	$109 - $1,743	12%
Aetna	$128 - $3,202	14%
Veterans Affairs Community Care Network	$128 - $1,191	14%
Blue Cross Blue Shield	$135 - $3,034	15%
UnitedHealthcare	$228 - $9,020	25%
Capital District Physicians' Health Plan	$232 - $3,497	25%
Martins Point	$341 - $1,191	37%
Choicecare	$368 - $2,792	40%
St. Regis	$1,066 - $1,191	115%
Magnacare	$1,982 - $2,978	214%
Highmark Blueshield	$2,428 - $3,336	262%

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 $3,101.
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 The University of Vermont Health Network-Alice Hy 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.