CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: The University Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,142
Cash Discount Price: $1,230
vs. Medicare Baseline: 2.31x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at The University Hospital is $2,142. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,230. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.31x the Medicare baseline. Located in 150 Bergen St, Newark, NJ.

Cash / Self-Pay

$1,230

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,142

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: $1,230 (133%)

Insurance Median: $2,142 (231%)

Cash: $1,230 (133% of Medicare)

Ins. Median: $2,142 (231% 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 231% of the Medicare baseline (a markup of 131%). 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
Horizon	$523 - $2,142	56%
Amerihealth	$550 - $1,069	59%
Aetna	$960 - $1,745	104%
Fidelis	$960 - $1,069	104%
UnitedHealthcare	$960 - $1,069	104%
Wellpoint	$979	106%
Clover Health	$1,069	115%
First Health	$2,288	247%
Americare	$2,452	265%
Qualcare	$2,452	265%
United	$2,568	277%
Correctional Medical Services	$2,615	282%
Multiplan	$2,615	282%
First Trenton	$2,942	317%
Managed Care Inc	$2,942	317%
Consumer Health Network	$3,106	335%
Three Rivers	$3,106	335%

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 $1,230.
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 The University 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.