CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Nassau University Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,109
Cash Discount Price: $1,026
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Nassau University Medical Center is $1,109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,026. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.20x the Medicare baseline. Located in 2201 Hempstead Turnpike, East Meadow, NY.

Cash / Self-Pay

$1,026

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,109

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: $1,026 (111%)

Insurance Median: $1,109 (120%)

Cash: $1,026 (111% of Medicare)

Ins. Median: $1,109 (120% 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
Blue Cross Blue Shield	$132 - $1,109	14%
Molina Healthcare (Fka Affinity)	$132	14%
Centers Plan For Healthy Living	$155 - $1,109	17%
Fidelis Care	$155 - $1,187	17%
Aetna	$185 - $1,617	20%
Emblemhealth	$272 - $1,622	29%
Humana	$484 - $1,109	52%
UnitedHealthcare	$1,109	120%
1199Seiu National Benefit Funds	$1,714	185%
Cigna	$3,079	332%

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 $1,026.
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 Nassau University 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.