CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Cleveland Clinic Indian River Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $282
Cash Discount Price: $668
vs. Medicare Baseline: 0.30x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Cleveland Clinic Indian River Hospital is $282. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $668. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.30x the Medicare baseline. Located in 1000 36Th St, Vero Beach, FL.

Cash / Self-Pay

$668

Average discount available for prompt cash payment at this facility.

Insurance Median

$282

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: $668 (72%)

Insurance Median: $282 (30%)

Cash: $668 (72% of Medicare)

Ins. Median: $282 (30% 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
Avmed	$140 - $2,155	15%
Blue Cross Blue Shield	$140 - $4,075	15%
Careplus	$140 - $941	15%
Magellan	$140	15%
United	$140 - $2,728	15%
Value Options	$140 - $282	15%
Wellcare	$140 - $941	15%
Freedom Health	$147 - $941	16%
Independent Living Systems	$147 - $988	16%
Wellmed	$147 - $941	16%
Clear Spring Health	$151	16%
Aetna	$168 - $4,061	18%
Cigna	$188 - $242	20%
UnitedHealthcare	$268	29%
Amerihealth	$282	30%
Medicaid / KanCare	$282	30%
Molina	$282	30%
Clarity Health	$668	72%
The Legacy Companies	$668	72%
National Provider Network	$720	78%
Three Rivers	$720	78%
Consociate Health	$771	83%
Carelon Bh Strategies	$941	102%
Humana	$941	102%
Devoted Health	$1,035	112%

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 $668.
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 Indian River 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.