CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: NYU Langone Hospitals

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,549
Cash Discount Price: $278
vs. Medicare Baseline: 2.75x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at NYU Langone Hospitals is $2,549. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $278. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.75x the Medicare baseline. Located in 550 First Avenue, New York, NY.

Cash / Self-Pay

$278

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,549

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: $278 (30%)

Insurance Median: $2,549 (275%)

Cash: $278 (30% of Medicare)

Ins. Median: $2,549 (275% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 275% of the Medicare baseline (a markup of 175%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$447 - $2,549	48%
Ghi	$1,109 - $12,574	120%
Hip	$1,109 - $8,427	120%
Medicare (plans)	$1,109	120%
Wellcare	$1,109	120%
Centerlight	$1,132	122%
Amida	$1,133	122%
Fidelis	$1,133 - $2,549	122%
Healthplus	$1,133 - $2,549	122%
Medicaid / KanCare	$1,133	122%
Metroplus	$1,133 - $2,549	122%
UnitedHealthcare	$1,133 - $8,609	122%
Multiplan	$1,142	123%
Somos	$1,190 - $1,529	128%
Aetna	$1,464 - $8,442	158%
Hamaspik	$2,219 - $2,929	239%
Oscar	$4,038	436%
Oxford	$5,039 - $7,620	544%
1199	$5,050 - $5,941	545%
Blue Cross Blue Shield	$5,867 - $7,334	633%
Cigna	$6,487	700%
Magnacare	$6,726 - $13,453	726%

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 $278.
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 NYU Langone Hospitals 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.