CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: HCA Florida Englewood Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,597
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.80x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at HCA Florida Englewood Hospital is $2,597. 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 2.80x the Medicare baseline. Located in 700 Medical Blvd, Englewood, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,597

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: $2,597 (280%)

Ins. Median: $2,597 (280% 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 280% of the Medicare baseline (a markup of 180%). 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
Corvel Corporation	$1,427 - $2,672	154%
Rockport Healthcare Group	$1,427 - $2,672	154%
Prime Health	$1,457 - $2,728	157%
Access 2 Healthcare Physicians Freedom Optimum Group Members	$1,638	177%
Truli	$1,933 - $2,662	209%
Access 2 Healthcare Physicians Freedom Health	$1,950	210%
Access 2 Healthcare Physicians Optimum	$1,950	210%
Freedom Health Care	$1,950	210%
Molina	$1,950 - $2,702	210%
Optimum Healthcare	$1,950	210%
Blue Cross Blue Shield	$2,049 - $5,462	221%
Simply Healthcare	$2,250 - $3,129	243%
Behealthy America	$2,550	275%
United	$3,611	390%
Oscar	$4,291	463%
Avmed	$4,922 - $12,418	531%
Cigna	$8,253	891%

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 $X.
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 HCA Florida Englewood 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.