CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Albany Medical Center Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $358
Cash Discount Price: $725
vs. Medicare Baseline: 0.39x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Albany Medical Center Hospital is $358. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $725. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.39x the Medicare baseline. Located in 43 New Scotland Avenue, Mail Code 34, Albany, NY.

Cash / Self-Pay

$725

Average discount available for prompt cash payment at this facility.

Insurance Median

$358

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: $725 (78%)

Insurance Median: $358 (39%)

Cash: $725 (78% of Medicare)

Ins. Median: $358 (39% 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
Cdphp	$87 - $5,076	9%
Medicare (plans)	$96 - $392	10%
Fidelis	$101 - $2,171	11%
Medicaid / KanCare	$101 - $355	11%
Blue Cross Blue Shield	$105 - $3,466	11%
Tricare	$109 - $341	12%
Hamaspik	$119 - $2,268	13%
Blue Shield Highmark	$120 - $737	13%
Mvp	$125 - $1,054	13%
UnitedHealthcare	$128 - $3,360	14%
Aetna	$133 - $5,476	14%
Nascentia	$141 - $375	15%
Emblem Health Ghi	$142 - $740	15%
Nascentia Health Options	$185	20%
Emblem	$190 - $5,696	21%
Cigna	$194 - $623	21%
Nys Department Of Corrections	$308 - $775	33%
Magnacare	$613 - $3,360	66%
Multiplan	$651 - $3,570	70%
Blue Shield	$1,024 - $5,093	111%
Mvp Essential Plan	$2,075	224%
Empire Plan Nyship	$3,466	374%
Mvp Commercial	$3,470 - $4,563	374%
Emblem_Ghi	$7,595	820%

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 $725.
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 Albany Medical Center 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.