CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Piedmont Augusta Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,571
Cash Discount Price: $1,071
vs. Medicare Baseline: 1.70x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Piedmont Augusta Hospital is $1,571. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,071. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.70x the Medicare baseline. Located in 1350 Walton Way, Augusta, GA.

Cash / Self-Pay

$1,071

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,571

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: $1,071 (116%)

Insurance Median: $1,571 (170%)

Cash: $1,071 (116% of Medicare)

Ins. Median: $1,571 (170% 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
Absolute Total Care [20109]	$526	57%
Blue Cross Blue Shield	$578 - $3,217	62%
Medicaid / KanCare	$839	91%
Alliant Health Plans Of Georgia [10952]	$1,321	143%
Alliant Solocare [11101]	$1,321	143%
Multiplan [10600]	$1,571	170%
Phcs [10601]	$1,571	170%
UnitedHealthcare	$2,192 - $3,372	237%
Industry Buying Group [10840]	$2,321	250%
Kaiser [10500]	$2,642	285%
First Health [10303]	$3,035	328%
Aetna	$3,127	337%
Novanet [10819]	$3,213	347%
Cigna	$3,570	385%

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 $1,071.
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 Piedmont Augusta 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.