CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Memorial Hospital and Manor

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $552
Cash Discount Price: $466
vs. Medicare Baseline: 0.60x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Memorial Hospital and Manor is $552. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $466. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.60x the Medicare baseline. Located in 1500 E Shotwell Street, Bainbridge, GA.

Cash / Self-Pay

$466

Average discount available for prompt cash payment at this facility.

Insurance Median

$552

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: $466 (50%)

Insurance Median: $552 (60%)

Cash: $466 (50% of Medicare)

Ins. Median: $552 (60% 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
Amerigroup_Plan	$419	45%
Medicaid / KanCare	$419	45%
Peach_State_Health_Plan_Plan	$419	45%
Caresource_Plan	$440	47%
Tnga_Plan	$450	49%
Blue Cross Blue Shield	$514	55%
Humana	$519 - $758	56%
Aetna	$525 - $758	57%
Uhc_Plan	$525	57%
Novanet_Plan	$532	57%
Cigna	$552	60%
Private_Healthcare_Systems_Plan	$565	61%
Multiplan_Plan	$598	65%
Corvel_Plan	$632	68%
Tricare	$705	76%
Medicare (plans)	$758	82%
Wellcare_Plan	$758	82%
Ambetter / Centene	$985	106%
Alliant_Plan	$1,213	131%

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 $466.
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 Memorial Hospital and Manor 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.