CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Athur M Blank Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $3,860
Cash Discount Price: $5,632
vs. Medicare Baseline: 4.17x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Athur M Blank Hospital is $3,860. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,632. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 4.17x the Medicare baseline. Located in 2220 North Druid Hills Road Ne, Atlanta, GA.

Cash / Self-Pay

$5,632

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,860

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: $5,632 (608%)

Insurance Median: $3,860 (417%)

Cash: $5,632 (608% of Medicare)

Ins. Median: $3,860 (417% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 417% of the Medicare baseline (a markup of 317%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Peachstate [43]	$2,407	260%
Caresource [61]	$2,474	267%
Amerigroup [102]	$2,592	280%
Cigna	$3,723	402%
Blue Cross Blue Shield	$3,737 - $5,498	403%
United [5]	$3,737	403%
Ambetter / Centene	$3,771	407%
Oscar [228]	$3,773	407%
Aetna	$3,790	409%
Caresource Marketplace Bronze/Silver/Gold [60]	$3,827	413%
Kaiser [6]	$3,835	414%
Sidecar Health [236]	$3,886	419%
Direct Employer Agreements [72]	$3,942 - $4,787	425%
Coventry [9]	$3,953	427%
Northeast Georgia Heatlh System [808]	$4,224	456%
Veracity Benefits [809]	$4,224	456%
First Health [74]	$4,227	456%
Phcs [93]	$4,787	517%
Secure Health [340]	$4,787	517%
Beech Street [71]	$5,069	547%
Multiplan [92]	$5,519	596%
Novanet [41]	$5,632	608%

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 $5,632.
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 Athur M Blank 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.