CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: St John's Riverside Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,127
Cash Discount Price: $2,649
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at St John's Riverside Hospital is $1,127. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,649. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.22x the Medicare baseline. Located in 976 North Broadway, Yonkers, NY.

Cash / Self-Pay

$2,649

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,127

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: $2,649 (286%)

Insurance Median: $1,127 (122%)

Cash: $2,649 (286% of Medicare)

Ins. Median: $1,127 (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
Fidelis Health Benefit Exchange	$1,070	115%
Aetna	$1,127 - $3,783	122%
Centers Plan For Healthy Living	$1,127	122%
Fidelis	$1,127	122%
Healthfirst	$1,127	122%
Hip Health Plan	$1,127	122%
Magnacare	$1,127	122%
Medicare (plans)	$1,127	122%
Mvp	$1,127	122%
Mvp Bhs	$1,127	122%
Oscar	$1,127 - $1,183	122%
Partners Health Plan	$1,127	122%
United Behavioral Health Of Ny Ipa	$1,127	122%
Village Caremax	$1,127	122%
Wellcare	$1,127	122%
Metroplus Gold	$1,183	128%
Blue Cross Blue Shield	$1,465	158%
Empire Hmo	$1,465	158%
1199 Seiu National Benefit Funds	$1,648	178%
Emblem Health	$3,174 - $3,770	343%
Cigna	$3,370	364%
Mvp Individual Exchange.Student Health Plan	$3,966	428%
Mvp Commercial	$4,676	505%
UnitedHealthcare	$5,048	545%

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 $2,649.
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 St John's Riverside 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.