CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Riverview Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $3,215
Cash Discount Price: $1,038
vs. Medicare Baseline: 3.47x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Riverview Medical Center is $3,215. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,038. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 3.47x the Medicare baseline. Located in One Riverview Plaza, Red Bank, NJ.

Cash / Self-Pay

$1,038

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,215

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: $1,038 (112%)

Insurance Median: $3,215 (347%)

Cash: $1,038 (112% of Medicare)

Ins. Median: $3,215 (347% 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 347% of the Medicare baseline (a markup of 247%). 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	$282	30%
Aetna	$579 - $8,419	62%
Clover	$739	80%
Seoul Medical Group	$891	96%
Blue Cross Blue Shield	$1,038	112%
Vaccn	$1,038	112%
Wellcare	$1,038	112%
United Community/Americhoice	$1,090	118%
UnitedHealthcare	$1,189 - $7,690	128%
Horizon	$1,339 - $10,715	145%
Bergen Risk	$3,080	332%
Cigna	$3,140 - $3,514	339%
Qualcare	$3,190 - $6,256	344%
Activecare First McO	$3,490	377%
Multiplan - PHCS	$3,490	377%
Amerihealth	$3,551 - $4,022	383%
Oxford	$6,195	669%
Brighton Health Plan	$9,933	1072%

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 $1,038.
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 Riverview 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.