CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Cleveland Clinic Martin North Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $925
Cash Discount Price: $1,646
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Cleveland Clinic Martin North Hospital is $925. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,646. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.00x the Medicare baseline. Located in 200 Se Hospital Ave, Stuart, FL.

Cash / Self-Pay

$1,646

Average discount available for prompt cash payment at this facility.

Insurance Median

$925

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: $1,646 (178%)

Insurance Median: $925 (100%)

Cash: $1,646 (178% of Medicare)

Ins. Median: $925 (100% 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
Blue Cross Blue Shield	$136 - $6,861	15%
Avmed	$140 - $3,623	15%
Miami Childrens Health Plan	$140 - $941	15%
United	$140 - $3,287	15%
Careplus	$147 - $988	16%
Freedom Health	$147 - $988	16%
Independent Living Systems	$147 - $338	16%
Clear Spring Health	$151 - $187	16%
Aetna	$173 - $6,603	19%
Multiplan	$180 - $210	19%
Cigna	$188 - $2,347	20%
Amerihealth	$290	31%
Molina	$296	32%
Sunshine Health	$296	32%
Clarity Health	$668 - $3,033	72%
The Legacy Companies	$668 - $3,033	72%
Consociate Health	$771	83%
Humana	$941	102%
Wellcare	$941	102%
Devoted Health	$1,035	112%
Bmi	$1,393 - $2,566	150%

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 $1,646.
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 Cleveland Clinic Martin North 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.