CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Kaleida Health

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,211
Cash Discount Price: $1,117
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Kaleida Health is $1,211. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,117. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.31x the Medicare baseline. Located in 100 High Street, Buffalo, NY.

Cash / Self-Pay

$1,117

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,211

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: $1,117 (121%)

Insurance Median: $1,211 (131%)

Cash: $1,117 (121% of Medicare)

Ins. Median: $1,211 (131% 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
Ghi/Emblem Health	$153 - $1,528	17%
Ghi/Emblem Health - Wchob	$153 - $192	17%
Aetna	$160 - $3,205	17%
Magnacare	$160 - $2,995	17%
Magnacare - Wchob	$160 - $2,995	17%
Univera	$540 - $1,578	58%
Univera - Wchob	$540 - $1,534	58%
Independent Health Association	$659 - $1,792	71%
Independent Health Association - Wchob	$683 - $1,836	74%
Blue Cross Blue Shield	$772 - $4,225	83%
Tricare	$1,076	116%
Wellcare	$1,177	127%
Fidelis	$1,223	132%
UnitedHealthcare	$1,228	133%
Cigna	$1,325 - $1,608	143%

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 $1,117.
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 Kaleida Health 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.