CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Hackensack University Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $3,490
Cash Discount Price: $1,104
vs. Medicare Baseline: 3.77x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Hackensack University Medical Center is $3,490. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,104. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 3.77x the Medicare baseline. Located in 30 Prospect Ave, Hackensack, NJ.

Cash / Self-Pay

$1,104

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,490

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: $1,104 (119%)

Insurance Median: $3,490 (377%)

Cash: $1,104 (119% of Medicare)

Ins. Median: $3,490 (377% 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 377% of the Medicare baseline (a markup of 277%). 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
Karna	$290	31%
Clover	$739	80%
UnitedHealthcare	$883 - $8,568	95%
Aetna	$1,031 - $7,773	111%
Blue Cross Blue Shield	$1,104	119%
Horizon	$1,104 - $16,802	119%
Vaccn	$1,104	119%
Wellcare	$1,104	119%
United Community/Americhoice	$1,159	125%
Seoul Medical Group	$1,174	127%
Intergroup	$2,874	310%
Bergen Risk	$3,080	332%
Cigna	$3,285 - $3,734	355%
Lhp Health	$3,367	363%
Activecare First McO	$3,490	377%
Chn	$3,490	377%
Multiplan - PHCS	$3,490	377%
Qualcare	$3,621 - $3,654	391%
Brighton Health Plan	$3,695	399%
Oxford	$7,146	771%
Amerihealth	$8,013 - $8,904	865%

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 $1,104.
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 Hackensack University Medical Center 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.