CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Suny/Stony Brook University Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,971
Cash Discount Price: $5,741
vs. Medicare Baseline: 2.13x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Suny/Stony Brook University Hospital is $1,971. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,741. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.13x the Medicare baseline. Located in Health Sciences Center SUNY, Stony Brook, NY.

Cash / Self-Pay

$5,741

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,971

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: $5,741 (620%)

Insurance Median: $1,971 (213%)

Cash: $5,741 (620% of Medicare)

Ins. Median: $1,971 (213% 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 213% of the Medicare baseline (a markup of 113%). 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	$165	18%
Healthfirst Essential Plan 1/2	$250	27%
Healthfirst Essential Plan 3/4	$250	27%
Aetna	$1,127 - $5,417	122%
Blue Cross Blue Shield	$1,127 - $5,018	122%
Elderplan	$1,127	122%
Fidelis Care	$1,127	122%
Healthfirst Health Plan	$1,127	122%
UnitedHealthcare	$1,127 - $12,338	122%
Emblemhealth Hip Of Ny	$1,149 - $2,803	124%
Agewell New York	$1,239	134%
Centerlight	$1,465	158%
Partners Health Plan	$1,465	158%
Emblemhealth Hip Of Ny Select Care	$1,584 - $2,103	171%
Emblemhealth Ghi	$1,838 - $6,564	198%
Oxford Freedom And Liberty	$2,762 - $5,562	298%
Cigna	$5,171	558%
Brighton All Payer	$6,468	698%

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 $5,741.
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 Suny/Stony Brook University Hospital 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.