Upper endoscopy with biopsy
Facility: Northside Hospital Duluth
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $4,314
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 4.66x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 466% of the Medicare baseline (a markup of 366%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Us Dept Of Labor Wc | $228 | 25% |
| One Call Diagnostics | $476 | 51% |
| Mti | $595 | 64% |
| Homelink | $632 | 68% |
| Lantern | $1,082 | 117% |
| Kaiser | $1,099 - $4,358 | 119% |
| Ambetter / Centene | $1,960 - $10,726 | 212% |
| Genex/Priority Care Solutions | $1,965 | 212% |
| Spreemo | $1,965 | 212% |
| Authentic 4D | $2,210 | 238% |
| Streamline Imaging | $2,210 | 238% |
| Corvel Workers Comp | $2,456 | 265% |
| Employers Choice Network | $2,456 | 265% |
| Fieldale Farms Wc | $2,456 | 265% |
| Georgia Workers Compensation | $2,456 | 265% |
| Blue Cross Blue Shield | $3,194 - $34,850 | 345% |
| Clear Springs Eon Health | $3,864 - $4,231 | 417% |
| Medicare (plans) | $3,864 - $5,077 | 417% |
| UnitedHealthcare | $3,864 - $6,943 | 417% |
| Va Ccn | $3,864 - $4,231 | 417% |
| Aetna | $3,902 - $6,519 | 421% |
| Humana | $3,902 - $4,400 | 421% |
| Coventry | $3,941 - $30,000 | 425% |
| Wellcare | $3,979 - $4,358 | 429% |
| Pruitt Health Premier | $4,057 - $4,443 | 438% |
| Bccp | $4,314 | 466% |
| Cbww | $4,314 | 466% |
| Truths Community | $4,314 | 466% |
| Caresource | $4,358 - $18,600 | 470% |
| Clover Health | $4,442 | 479% |
| Fairly Group | $4,865 | 525% |
| Tricare | $5,140 | 555% |
| Cigna | $5,210 - $8,679 | 562% |
| Oscar | $5,940 | 641% |
| Amerigroup | $6,316 - $8,978 | 682% |
| Institutional Gwinnett County Govt | $6,316 - $8,978 | 682% |
| Medicaid / KanCare | $6,316 - $10,325 | 682% |
| Northside Health Network | $7,875 | 850% |
| Health One Alliance_Ppo | $12,000 | 1295% |
| Quick Trip | $27,500 | 2968% |
| Novanet_Ppo | $35,000 | 3777% |
| Phcs | $37,500 | 4047% |
| Champus Va | $50,000 | 5396% |
| Johnson Ferry Imaging | $50,000 | 5396% |
| Marietta Dermatology Clinical Research Inc | $50,000 | 5396% |
| West Paces Imaging Agreement | $50,000 | 5396% |