CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Montefiore St Luke's Cornwall

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$1,303

about 1.4× the $927 Medicare rate · typically $948–$3,400

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,234

About the fair price

about $69 under the fair price · 1.3× Medicare

Medicare pays $927 Fair price $1,303 This hospital $1,234 Cash price $1,132

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

Highest price of the 9 NY hospitals we have prices for — worth calling around.

Cheapest $110 Priciest $1,234

Black dot = this hospital, among the 9 NY hospitals with a price for this procedure. Full list below.

A fair price for a Upper endoscopy with biopsy is about $1,303 (about 1.4× the $927 Medicare rate). Montefiore St Luke's Cornwall charges insurers about $1,234, or about $1,132 in cash — about the fair price. Located in Newburgh, NY.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Humana CignaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$1,132 - $4,457	122%
Blue Cross Blue Shieldmajor	$664 - $3,713	72%
Aetnamajor	$1,121 - $3,470	121%
Humanamajor	$1,245	134%
CDPHP	$1,132 - $2,811	122%
Fidelis Care	$1,132 - $1,313	122%
GEHA	$2,086 - $3,470	225%
MagnaCare	$810 - $3,000	87%
MVP Health Care	$1,647	178%
Oscar Health	$1,132 - $7,276	122%
WellCare	$1,166	126%
+ 13 smaller / regional plans	$536 - $9,638

Government programs also on file: Medicaid.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 1,132), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Montefiore St Luke's Cornwall is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Montefiore St Luke's Cornwall

Compare: Upper endoscopy with biopsy at other NY hospitals

Insurance negotiated median for the same procedure, sorted lowest first.