CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Montefiore St Luke's Cornwall

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,223
Cash Discount Price: $1,132
vs. Medicare Baseline: 1.32x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Montefiore St Luke's Cornwall is $1,223. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,132. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.32x the Medicare baseline. Located in 70 Dubois Street, Newburgh, NY.

Cash / Self-Pay

$1,132

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,223

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: $1,132 (122%)

Insurance Median: $1,223 (132%)

Cash: $1,132 (122% of Medicare)

Ins. Median: $1,223 (132% 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
Emblem	$536 - $9,638	58%
Healthfirst	$551 - $1,390	59%
Affinity	$664 - $1,189	72%
Blue Cross Blue Shield	$664 - $3,713	72%
Medicaid / KanCare	$664	72%
Hamaspik	$698 - $1,223	75%
Magnacare	$810 - $3,000	87%
Mediblue	$1,098	118%
Aetna	$1,121 - $3,470	121%
Cdphp	$1,132 - $2,811	122%
Fidelis	$1,132 - $1,313	122%
Hudson Valley	$1,132	122%
Oscar	$1,132 - $7,276	122%
Point Comfort	$1,132	122%
UnitedHealthcare	$1,132 - $4,457	122%
Villagecaremax	$1,132	122%
Vnsny Choice	$1,132	122%
Centerlight	$1,166	126%
Wellcare	$1,166	126%
Humana	$1,245	134%
Mvp	$1,647	178%
Geha	$2,086 - $3,470	225%
Meritain Health	$2,086 - $3,470	225%
Nippon Life Insurance	$2,086 - $3,470	225%
Northwell	$3,046	329%
American Postal Workers	$4,457	481%
Seiu1199	$5,826	629%

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 $1,132.
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 Montefiore St Luke's Cornwall 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.