CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Good Samaritan Hospital of Suffern

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $4,210
Cash Discount Price: $1,718
vs. Medicare Baseline: 4.54x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Good Samaritan Hospital of Suffern is $4,210. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,718. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 4.54x the Medicare baseline. Located in 255 Lafayette Avenue, Suffern, NY.

Cash / Self-Pay

$1,718

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,210

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: $1,718 (185%)

Insurance Median: $4,210 (454%)

Cash: $1,718 (185% of Medicare)

Ins. Median: $4,210 (454% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 454% of the Medicare baseline (a markup of 354%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Mvp Gold (McR)	$1,127	122%
Medicare (plans)	$1,127 - $1,205	122%
World Trade Center Fdny	$1,127	122%
World Trade Center Other	$1,127	122%
Hamaspik (McR)	$1,127	122%
Affinity By Molina McR	$1,183	128%
Beacon Exchange	$1,352	146%
Beacon Commercial	$1,465	158%
Geisinger Health Commercial/Exchange	$3,718	401%
Oxford	$3,865 - $4,137	417%
Magnacare	$3,901	421%
UnitedHealthcare	$3,907 - $4,927	422%
Blue Cross Blue Shield	$3,966 - $5,017	428%
Magnacare Preferred	$4,135	446%
Oxford Commercial	$4,143	447%
Oxford Exchange	$4,188	452%
Self-Pay	$5,500	594%
Cigna	$5,738	619%
Tricare	$6,217	671%
Aetna	$6,250 - $6,944	674%
Mvp	$6,258 - $7,363	675%
Mvp Exchange	$6,508	702%
Mvp Hmo/Ppo	$14,367	1550%

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 $1,718.
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 Good Samaritan Hospital of Suffern 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.