CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Jacobi Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,244
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Jacobi Medical Center is $1,244. 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 1.34x the Medicare baseline. Located in 1400 Pelham Parkway South, Bronx, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,244

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: $1,244 (134%)

Ins. Median: $1,244 (134% 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
Healthfirst	$124 - $2,240	13%
Aetna	$168 - $2,177	18%
Wellcare	$168 - $1,957	18%
Fidelis	$224 - $2,240	24%
Metroplus	$265 - $2,240	29%
Carelon	$758 - $2,120	82%
Oxford	$781 - $2,648	84%
Local 1199	$796 - $2,334	86%
United	$944 - $3,275	102%
Emblem	$977 - $4,821	105%
Amidacare	$995	107%
Blue Cross Blue Shield	$995 - $2,240	107%
Senior Whole Health	$995	107%
United Behavioral Health	$995 - $1,095	107%
Affinity	$1,015 - $2,240	110%
Carelon (Amida Care)	$1,015	110%
Vnsny	$1,015 - $2,772	110%
Elderplan	$1,109 - $2,120	120%
Vaccn	$1,109	120%
Centers Plan For Healthy Living	$1,154	125%
Oscar	$1,396 - $4,454	151%
Cigna	$1,500 - $4,285	162%
Centerlight	$1,563 - $1,631	169%
Magnacare	$2,344 - $2,446	253%
Multiplan	$2,501 - $2,609	270%
Villagecare Max	$2,657 - $2,772	287%

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 Jacobi 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.