CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: H. Lee Moffitt Cancer Center and Research Institute Hospital, Inc.

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $228
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.25x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at H. Lee Moffitt Cancer Center and Research Institute Hospital, Inc. is $228. 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 0.25x the Medicare baseline. Located in 12902 Magnolia Dr, Tampa, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$228

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: $228 (25%)

Ins. Median: $228 (25% 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
Simply	$103	11%
United Hc	$108 - $7,883	12%
Blue Cross Blue Shield	$136 - $566	15%
Aetna	$138 - $402	15%
Devoted	$138 - $363	15%
Humana	$138 - $363	15%
Careplus	$145 - $381	16%
Baycare	$148 - $388	16%
Freedom Health	$152 - $399	16%
Optimum	$152 - $399	16%
Evolutions	$163 - $428	18%
Avmed	$194 - $508	21%
Health First	$208 - $544	22%
Multiplan	$221 - $581	24%
Cigna	$235	25%

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 H. Lee Moffitt Cancer Center and Research Institute Hospital, Inc. 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.