CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Greater Baltimore Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $402
Cash Discount Price: $766
vs. Medicare Baseline: 0.43x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Greater Baltimore Medical Center is $402. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $766. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.43x the Medicare baseline. Located in 6701 North Charles Street, Baltimore, MD.

Cash / Self-Pay

$766

Average discount available for prompt cash payment at this facility.

Insurance Median

$402

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: $766 (83%)

Insurance Median: $402 (43%)

Cash: $766 (83% of Medicare)

Ins. Median: $402 (43% 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	$274 - $454	30%
Md Physician Care [237]	$274	30%
Medicaid / KanCare	$274	30%
Priority Partners [241]	$274	30%
UnitedHealthcare	$274 - $553	30%
Wellpoint [235]	$274	30%
Alterwood Health [290]	$279	30%
Jai Medical Services [236]	$288	31%
Carefirst Maryland Health Advantage Mca [264]	$402	43%
Carefirst [201]	$402 - $793	43%
Cfchp Mco [239]	$402	43%
Cigna	$402 - $512	43%
Communicare Advantage [300]	$402	43%
Humana	$402	43%
Johns Hopkins [213]	$402 - $539	43%
Keycare Advantage [299]	$402	43%
Medicare (plans)	$402	43%
Multiplan/Phcs [296]	$402 - $523	43%
Provider Partners Health Plan [298]	$402	43%
Carefirst Blue Choice Hmo [253]	$478 - $729	52%
Carefirst Administrator [252]	$520 - $793	56%
First Health Network [268]	$523	56%
Kaiser Permanente Hmo [231]	$567	61%
Usa Managed Care Organization [301]	$616	66%

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 $766.
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 Greater Baltimore 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.