CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Kings County Hospital Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,009
Cash Discount Price: $1,038
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Kings County Hospital Center is $1,009. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,038. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.09x the Medicare baseline. Located in 451 Clarkson Avenue, Brooklyn, NY.

Cash / Self-Pay

$1,038

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,009

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: $1,038 (112%)

Insurance Median: $1,009 (109%)

Cash: $1,038 (112% of Medicare)

Ins. Median: $1,009 (109% 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	$78 - $2,225	8%
Affinity	$137 - $2,225	15%
Blue Cross Blue Shield	$155 - $2,225	17%
Centerlight	$155 - $1,631	17%
Elderplan	$155 - $2,120	17%
Fidelis	$155 - $2,225	17%
Wellcare	$158 - $1,957	17%
Centers Plan For Healthy Living	$162 - $1,154	17%
Hamaspik	$163	18%
Aetna	$168 - $2,177	18%
Local 1199	$174 - $2,334	19%
Oscar	$194 - $4,454	21%
Metroplus	$265 - $2,225	29%
Carelon	$758 - $2,120	82%
Oxford	$781 - $2,648	84%
United	$944 - $3,275	102%
Emblem	$977 - $4,821	105%
Amidacare	$989	107%
Senior Whole Health	$989	107%
United Behavioral Health	$989 - $1,088	107%
Carelon (Amida Care)	$1,009	109%
Vnsny	$1,009 - $2,772	109%
Vaccn	$1,109	120%
Cigna	$1,500 - $4,285	162%
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 $1,038.
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 Kings County Hospital 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.