CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Westchester Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $5,804
Cash Discount Price: $3,949
vs. Medicare Baseline: 6.26x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Westchester Medical Center is $5,804. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,949. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 6.26x the Medicare baseline. Located in 100 Woods Rd, Valhalla, NY.

Cash / Self-Pay

$3,949

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,804

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: $3,949 (426%)

Insurance Median: $5,804 (626%)

Cash: $3,949 (426% of Medicare)

Ins. Median: $5,804 (626% 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 626% of the Medicare baseline (a markup of 526%). 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
Blue Cross Blue Shield	$2,848 - $3,797	307%
Mvp	$3,604 - $4,318	389%
Magnacare	$4,051 - $5,006	437%
UnitedHealthcare	$5,215 - $7,255	563%
Aetna	$5,400 - $7,060	583%
Oxford	$5,522 - $7,255	596%
Cdphp	$5,608 - $8,355	605%
Cigna	$6,379	688%
Emblem	$6,795	733%

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 $3,949.
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 Westchester 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.