CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Atrium Health Navicent the Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $669
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.72x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Atrium Health Navicent the Medical Center is $669. 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 0.72x the Medicare baseline. Located in 777 Hemlock Street, Macon, GA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$669

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: $669 (72%)

Ins. Median: $669 (72% 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
Aetna	$128 - $5,079	14%
Blue Cross Blue Shield	$128 - $2,433	14%
Georgia Health Advantage	$128 - $914	14%
Humana	$128 - $4,453	14%
UnitedHealthcare	$128 - $914	14%
Care Source	$131 - $932	14%
Clover	$131 - $932	14%
Eon Health	$131 - $932	14%
Pruitt Health	$135 - $914	15%
Alliant	$154 - $2,309	17%
Ambetter / Centene	$173	19%
Cigna	$517 - $2,875	56%
Securehealth	$628	68%
Kaiser	$692 - $1,997	75%

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 Atrium Health Navicent the Medical Center 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.