CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: UF Health Shands Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,039
Cash Discount Price: $2,278
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at UF Health Shands Hospital is $1,039. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,278. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.12x the Medicare baseline. Located in 1600 Sw Archer Rd, Gainesville, FL.

Cash / Self-Pay

$2,278

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,039

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: $2,278 (246%)

Insurance Median: $1,039 (112%)

Cash: $2,278 (246% of Medicare)

Ins. Median: $1,039 (112% 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
Beacon Health Strategies	$714	77%
Humana	$714 - $957	77%
Sunshine State Health Plan	$714	77%
UnitedHealthcare	$714 - $985	77%
Aetna	$742 - $3,413	80%
Florida Community Care	$746	81%
Simply Healthcare	$776	84%
Amerihealth Caritas Florida	$779	84%
Community Care Plan	$779	84%
Molina	$779	84%
Blue Cross Blue Shield	$941 - $3,233	102%
Vha	$941	102%
Capital Health Plan	$947 - $2,071	102%
North Central Hospice	$947	102%
Wellcare	$947	102%
Careplus	$976	105%
Carelon Health	$1,005	108%
Positive Healthcare Partners	$1,035	112%
Ahf Mco Of Fl	$1,042	112%
Devoted Health Plan	$1,042	112%
Freedom Health- Inc./Optimum Healthcare- Inc.	$1,042	112%
Ghilcrest County	$1,176	127%
Levy County	$1,176	127%
Wellpath	$1,506	163%
Ambetter / Centene	$1,562	169%
Uaa	$1,578	170%
Florida Health Care Plan	$1,694	183%
Avmed	$1,797 - $1,973	194%
Northeast Fl Hospital	$1,822	197%
Health First	$2,899	313%
Prime Health Services	$2,899	313%
Archbold Medical Center	$3,106	335%
Genex	$3,106	335%
Cigna	$3,350	362%
Geha	$3,728	402%

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 $2,278.
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 UF Health Shands 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.