CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Jamaica Hospital Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,194
Cash Discount Price: $1,500
vs. Medicare Baseline: 1.29x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Jamaica Hospital Medical Center is $1,194. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,500. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.29x the Medicare baseline. Located in 89Th Avenue and Van Wyck Expressway, Jamaica, NY.

Cash / Self-Pay

$1,500

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,194

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: $1,500 (162%)

Insurance Median: $1,194 (129%)

Cash: $1,500 (162% of Medicare)

Ins. Median: $1,194 (129% 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
1999 National Benefit Fund	$174 - $4,001	19%
Ghi	$182 - $4,077	20%
World Trade Center Program	$287	31%
UnitedHealthcare	$701 - $4,215	76%
Healthfirst	$958	103%
Fidelis	$1,070 - $1,127	115%
Aetna	$1,127 - $2,914	122%
Beacon Health Strategies	$1,127	122%
Centerlight Healthcare	$1,127	122%
Empire	$1,127 - $3,333	122%
Hip	$1,127 - $5,159	122%
Metroplus	$1,127 - $1,239	122%
Elderplan	$1,149	124%
Vns	$1,149	124%
Wellcare Of Ny	$1,172	126%
Villagecaremax	$1,183	128%
Humana	$1,194	129%
Senior Whole Health	$1,194	129%
Hamaspik Choice	$1,296	140%
Magnacare	$1,296 - $4,555	140%
Centers Plan For Healthy Living	$1,408	152%
Emblemhealth	$1,859	201%
Hotel Trades Council	$1,912	206%
Empire Blue Priority	$2,833	306%
Create Health Plan	$3,399	367%
Oscar	$4,018	434%
Cigna	$4,250	459%
Centivo	$4,679	505%

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 $1,500.
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 Jamaica Hospital 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.