CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Hackensack Meridian Health Pascack Valley Medical

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,360
Cash Discount Price: $1,285
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Hackensack Meridian Health Pascack Valley Medical is $1,360. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,285. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.47x the Medicare baseline. Located in 250 Old Hook Road, Westwood, NJ.

Cash / Self-Pay

$1,285

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,360

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: $1,285 (139%)

Insurance Median: $1,360 (147%)

Cash: $1,285 (139% of Medicare)

Ins. Median: $1,360 (147% 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.

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
Healthscope Benefits [2290]	$130 - $1,360	14%
UnitedHealthcare	$130 - $258	14%
Medicaid / KanCare	$232 - $244	25%
Medicare (plans)	$288	31%
Aetna	$352	38%
Black Lung [6055]	$656	71%
Commercial Generic [1285]	$656	71%
Create Flex / Select [3580]	$656	71%
Healthcare Highways [2210]	$656 - $1,360	71%
Horizon [3625]	$656	71%
Lucent Health [6000]	$656	71%
Oncology Patient Assistance Programs [2295]	$656	71%
Selecthealth [3740]	$656	71%
Web Tpa [2115]	$656	71%
Worker's Comp [2125]	$656	71%
Wtc Healthcare Sme Karna [8005]	$656	71%
Administrative Concepts [1005]	$1,360	147%
Allied National Global Care [1035]	$1,360	147%
First Health [1375]	$1,360	147%
Gilsbar [1425]	$1,360	147%
Healthcost Solutions [2415]	$1,360	147%
Healthfirst [2395]	$1,360	147%
Healthnet [1495]	$1,360	147%
Hometown Health [2155]	$1,360	147%
Mayo Clinic Health Solutions [2280]	$1,360	147%
Multiplan [1680]	$1,360	147%
Mutual of Omaha [1685]	$1,360	147%
New Era Life Insurance Company [1705]	$1,360	147%
PHCS [1780]	$1,360	147%
Pan American Life Insurance Co [1770]	$1,360	147%
Pba [1775]	$1,360	147%
Planned Administrators Inc [2360]	$1,360	147%
Resource One Administrators [2815]	$1,360	147%
Trustmark [2030]	$1,360	147%
Universal Fidelity [2085]	$1,360	147%
Emblem Health [2430]	$1,552	167%
Humana	$1,552	167%
Qualcare [3725]	$1,552	167%

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 $1,285.
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 Meridian Health Pascack Valley Medical 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.