CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Phoebe Sumter Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,052

about 1.1× the $927 Medicare rate · typically $820–$2,052

modeled estimate · not a bill or quote

Medicare pays $927 Fair price $1,052 Cash price $538 Hospital's list price $896

How we calculate the fair BaseRate →

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

1 of 6 major insurers have a published price at this hospital

✓ Aetna UnitedHealthcareBlue Cross Blue ShieldCignaHumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
Aetnamajor	$811 - $1,232	88%
Ambetter (Centene)	$1,391	150%
Clover Health	$819	88%
+ 2 smaller / regional plans	$835 - $1,152

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 538), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Phoebe Sumter Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Phoebe Sumter Medical Center

Compare: Upper endoscopy with biopsy at other GA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.