CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Columbia Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $392
Cash Discount Price: $796
vs. Medicare Baseline: 0.42x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Columbia Memorial Hospital is $392. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $796. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.42x the Medicare baseline. Located in 71 Prospect Avenue, Hudson, NY.

Cash / Self-Pay

$796

Average discount available for prompt cash payment at this facility.

Insurance Median

$392

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: $796 (86%)

Insurance Median: $392 (42%)

Cash: $796 (86% of Medicare)

Ins. Median: $392 (42% 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
UnitedHealthcare	$57 - $2,815	6%
Mvp	$100 - $2,027	11%
Medicaid / KanCare	$101 - $965	11%
Cdphp	$103 - $3,816	11%
Medicare (plans)	$108 - $392	12%
Blue Cross Blue Shield	$122 - $2,614	13%
Tricare	$122 - $392	13%
Hamaspik	$134 - $1,313	14%
Fidelis	$136 - $2,172	15%
Aetna	$148 - $3,094	16%
Blue Shield Highmark	$153 - $477	17%
Cigna	$186 - $515	20%
Emblem	$190 - $2,022	21%
Emblem Health Ghi	$197 - $537	21%
Magnacare	$751 - $2,076	81%
Multiplan	$878 - $2,426	95%
Herrington Diversified Pdh	$975 - $1,664	105%
Blue Shield	$1,613 - $2,814	174%
Empire Plan Nyship	$2,614	282%
Mvp Commercial	$8,795	949%

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 $796.
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 Columbia Memorial 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.