CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Margaretville Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,910
Cash Discount Price: $2,640
vs. Medicare Baseline: 3.14x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Margaretville Memorial Hospital is $2,910. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,640. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 3.14x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$2,640

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,910

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: $2,640 (285%)

Insurance Median: $2,910 (314%)

Cash: $2,640 (285% of Medicare)

Ins. Median: $2,910 (314% 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 314% of the Medicare baseline (a markup of 214%). 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)	$1,162 - $22,000	125%
Blue Cross Blue Shield	$1,162 - $22,000	125%
Hamaspik (McR)	$1,162 - $22,000	125%
UnitedHealthcare	$1,162 - $22,000	125%
Medicare (plans)	$1,162 - $23,540	125%
Aetna	$1,162 - $22,000	125%
Affinity By Molina McR	$1,220 - $23,100	132%
Cdphp	$1,278 - $24,200	138%
Emblem Select Care (Exchange)	$1,795	194%
Magnacare Standard	$1,848	199%
Todays Options	$1,917	207%
Emblem Ghi/Hip Hmo/Epo/Pos	$2,112	228%
Multiplan	$2,165	234%
First Health	$2,376	256%
Mvp	$2,994	323%
Mvp Exchange	$3,114	336%
Self-Pay	$3,781	408%
Oxford	$3,897 - $4,331	421%
Oxford Exchange	$4,178	451%
Magnacare	$4,507	486%
Magnacare Preferred	$4,777	516%
Emblem Ghi/Hip Ppo/Cbp	$4,929	532%
Mvp Hmo/Ppo	$7,657	826%

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 $2,640.
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 Margaretville Memorial 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.