Upper endoscopy with biopsy
Facility: Mt Sinai Hospital Medical Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $972
- Cash Discount Price: $949
- vs. Medicare Baseline: 1.05x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Oscar - All Plans | $372 - $841 | 40% |
| Partners In Hlth - All Plans | $425 - $1,031 | 46% |
| Blue Cross Blue Shield | $475 - $1,473 | 51% |
| Lawndale Christian - All Plans | $619 - $1,803 | 67% |
| Compsych Ip/Op Only - All Plans | $637 - $1,546 | 69% |
| Healthlink Hmo | $691 - $1,580 | 75% |
| Hfn Platinum | $691 - $3,388 | 75% |
| Healthlink Ppo - All Other Plans | $744 - $1,663 | 80% |
| Multiplan Primary Ntwrk/Phcs - All Other Plans | $744 - $1,804 | 80% |
| Hfn Epo | $850 - $3,388 | 92% |
| Multiplan Complementary Ntwrk | $850 - $2,062 | 92% |
| UnitedHealthcare | $885 - $1,315 | 96% |
| Cigna | $914 - $3,186 | 99% |
| Hfn Ppo - All Other Plans | $935 - $2,268 | 101% |
| Tricare | $943 | 102% |
| Va Healthnet - All Plans | $943 | 102% |
| Advocate Physician Prtnrs Mcr | $972 | 105% |
| Cenpatico Illinicare Dual | $972 | 105% |
| Cenpatico Illinicare Mcr - All Other Plans | $972 | 105% |
| Humana | $972 - $8,093 | 105% |
| Meridian/Harmony D-Snp - All Plans | $972 | 105% |
| Nextlevel Hlth Icp Fhp Aca - All Plans | $972 | 105% |
| Harmony Behavioral Htlh - All Plans | $1,001 | 108% |
| Zing Mcr Adv - All Plans | $1,011 | 109% |
| Molina Mcr - All Other Plans | $1,021 | 110% |
| Advocate Physician Prtnrs - All Other Plans | $1,069 | 115% |
| Ambetter / Centene | $1,069 - $2,706 | 115% |
| Aetna | $1,473 - $5,825 | 159% |
| Family Health Network Mcaid - All Plans | $1,473 | 159% |
| Molina Mcaid | $1,547 | 167% |