CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Montefiore Mount Vernon Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,132
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Montefiore Mount Vernon Hospital is $1,132. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.22x the Medicare baseline. Located in 12 North 7Th Avenue, Mount Vernon, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,132

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%)

Insurance Median: $1,132 (122%)

Ins. Median: $1,132 (122% 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
American Postal Workers	$140 - $13,302	15%
UnitedHealthcare	$140 - $13,302	15%
Metroplus	$152 - $1,562	16%
Healthfirst	$510 - $1,414	55%
Amidacare	$868	94%
Blue Cross Blue Shield	$868 - $6,702	94%
Emblem	$868 - $9,640	94%
Fidelis	$868 - $1,519	94%
Medicaid / KanCare	$868	94%
Molina Healthcare Of Ny Affinity	$868 - $1,952	94%
Mvp	$868 - $1,779	94%
Wellcare	$876 - $1,155	95%
Hamaspik	$911 - $937	98%
Vnsny Choice	$998 - $1,132	108%
Vnsny Select Health	$998	108%
Point Comfort	$1,132	122%
Villagecaremax	$1,132	122%
Centerlight	$1,166 - $1,245	126%
Elderplan	$1,166	126%
Partners Health Plan	$1,189	128%
Longevity	$1,234	133%
Humana	$1,245	134%
Oscar	$1,908 - $7,276	206%
Northwell	$3,046	329%
Aetna	$3,885 - $4,346	419%

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 $X.
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 Montefiore Mount Vernon 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.