CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Harlem Hospital Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,231
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Harlem Hospital Center is $1,231. 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 1.33x the Medicare baseline. Located in 506 Lenox Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,231

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: $1,231 (133%)

Ins. Median: $1,231 (133% 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	$121 - $2,216	13%
Wellcare	$164 - $1,658	18%
Aetna	$168 - $2,177	18%
Fidelis	$218 - $2,216	24%
Metroplus	$898 - $2,216	97%
Amidacare	$985	106%
Blue Cross Blue Shield	$985 - $2,216	106%
Carelon	$985 - $1,796	106%
Senior Whole Health	$985	106%
United	$985 - $2,829	106%
United Behavioral Health	$985 - $1,083	106%
Affinity	$1,004 - $2,216	108%
Carelon (Amida Care)	$1,004	108%
Vnsny	$1,004 - $2,349	108%
Elderplan	$1,109 - $1,796	120%
Vaccn	$1,109	120%
Centers Plan For Healthy Living	$1,154	125%
Emblem	$1,231 - $4,821	133%
Centerlight	$1,382	149%
Magnacare	$2,072	224%
Multiplan	$2,211	239%
Local 1199	$2,334	252%
Oxford	$2,337 - $2,648	252%
Villagecare Max	$2,349	253%
Cigna	$4,285	462%
Oscar	$4,454	481%

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 Harlem 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.