CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Northwest Florida Community Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $237
Cash Discount Price: $289
vs. Medicare Baseline: 0.26x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Northwest Florida Community Hospital is $237. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $289. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.26x the Medicare baseline. Located in 1360 Brickyard Rd, Chipley, FL.

Cash / Self-Pay

$289

Average discount available for prompt cash payment at this facility.

Insurance Median

$237

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: $289 (31%)

Insurance Median: $237 (26%)

Cash: $289 (31% of Medicare)

Ins. Median: $237 (26% 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
Humana	$76 - $159	8%
Florida_Community_Care	$93	10%
Lighthouse	$93	10%
Sunshine	$93	10%
Wellcare	$93	10%
United_Healthcare	$134 - $312	14%
Blue_Cross_Nwb	$276 - $1,320	30%
Blue_Cross_Phs_Ppo	$276 - $1,332	30%
Cigna	$288 - $456	31%
Medicare (plans)	$454 - $718	49%

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 $289.
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 Northwest Florida Community 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.