CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Halifax Health Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 43239
  • Insurance Median: $941
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.02x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Halifax Health Medical Center is $941. 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 1.02x the Medicare baseline. Located in 303 N Clyde Morris Blvd, Daytona Beach, FL.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$941

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: $941 (102%)
Ins. Median: $941 (102% 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.

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
Embs $800 86%
Tricare $834 90%
Humana $913 - $1,873 99%
Aetna $941 - $1,878 102%
Americas Choice Provider Network $941 102%
Blue Cross Blue Shield $941 102%
Cigna $941 102%
Coventry $941 102%
Division Of The Blind $941 102%
Freedom Health $941 102%
Medicare (plans) $941 102%
Optimum Healthcare $941 102%
Sunshine State Health Plan $941 - $1,882 102%
UnitedHealthcare $941 102%
Wellcare $941 102%
Molina $960 104%
Devoted Health $979 106%
Independent Living Systems $988 107%
Longevity $988 107%
Prime Health Services $988 107%
Clear Spring Health Of Fl $1,026 111%
Evolutions $1,412 152%
Employers Health Network $1,882 203%
Fhcp $1,901 205%
Centivo $2,023 218%
Florida Healthcare $2,042 220%
Claimdoc $2,117 228%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 303 N Clyde Morris Blvd, Daytona Beach, FL 32114
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Acute Care Hospitals