Upper endoscopy with biopsy
Facility: University Medical Center of Princeton at Plainsboro
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $2,980
- Cash Discount Price: $5,082
- vs. Medicare Baseline: 3.22x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 322% of the Medicare baseline (a markup of 222%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Aetna | $469 - $4,233 | 51% |
| Medicaid / KanCare | $469 - $5,082 | 51% |
| Charity Care | $476 | 51% |
| Wellcare | $515 | 56% |
| Horizon Nj Health | $690 | 74% |
| Tricare | $1,020 | 110% |
| Blue Cross Blue Shield | $1,021 - $3,823 | 110% |
| Medicare (plans) | $1,034 - $1,138 | 112% |
| UnitedHealthcare | $1,034 - $5,050 | 112% |
| Va Medical Center | $1,034 | 112% |
| Cigna | $1,065 - $5,082 | 115% |
| Clover Health Plan | $1,096 | 118% |
| Humana | $1,117 | 121% |
| Us Family Health Plan | $1,173 | 127% |
| Amerihealth | $1,261 | 136% |
| Preferred Health Care Eliance | $1,321 | 143% |
| Princeton Theological Seminary | $1,431 | 154% |
| Elap | $1,469 - $1,862 | 159% |
| Qualcare | $1,545 - $4,320 | 167% |
| Private Healthcare Systems | $1,800 | 194% |
| Centivo | $1,862 | 201% |
| Claim Watcher | $1,862 | 201% |
| Horizon Behavioral Health | $1,905 | 206% |
| Beacon Health Options | $2,541 | 274% |
| Coventry | $3,557 | 384% |
| Health Net | $3,557 | 384% |
| Magnacare | $3,557 - $4,491 | 384% |
| Beech Street | $4,066 - $4,320 | 439% |
| Intergrated Health Plan | $4,066 | 439% |
| Intergroup | $4,066 | 439% |
| Penn Global Medicine Embassy Only | $4,066 | 439% |
| Allied Trades | $4,320 | 466% |
| Consumer Health Network | $4,320 | 466% |
| Devon Health Services | $4,320 | 466% |
| Ie Shaffer | $4,320 | 466% |
| Total Care Network | $4,320 | 466% |
| Tri-State | $4,320 | 466% |
| Commercial Other | $5,082 | 548% |
| Compsych | $5,082 | 548% |
| Concern Plus | $5,082 | 548% |
| International Pfs | $5,082 | 548% |
| Life St. Francis | $5,082 | 548% |
| Magellan | $5,082 | 548% |
| Managed Health Network | $5,082 | 548% |
| Nj Carpenters | $5,082 | 548% |
| Penn Behavioral Health Corporate Services | $5,082 | 548% |
| Personnel Health Program | $5,082 | 548% |
| United Behavioral Health | $5,082 | 548% |
| First Managed Care Option | $7,958 | 859% |