CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Duke University Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $255
Cash Discount Price: $1,145
vs. Medicare Baseline: 0.28x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Duke University Hospital is $255. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,145. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.28x the Medicare baseline. Located in 2301 Erwin Rd, Durham, NC.

Cash / Self-Pay

$1,145

Average discount available for prompt cash payment at this facility.

Insurance Median

$255

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: $1,145 (124%)

Insurance Median: $255 (28%)

Cash: $1,145 (124% of Medicare)

Ins. Median: $255 (28% 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
Humana	$65 - $615	7%
Amerihealth	$66 - $255	7%
Blue Cross Blue Shield	$66 - $1,688	7%
Carolina Complete Health	$66 - $255	7%
UnitedHealthcare	$66 - $868	7%
Aetna	$94 - $2,001	10%
Piedmont Health	$118	13%
Troy Health	$118	13%
Voans	$118	13%
Cigna	$120 - $957	13%
Liberty	$120	13%
Alliance Health	$133	14%
Partners	$133	14%
Trillium	$133	14%
Sentara	$300	32%

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 $1,145.
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 Duke University 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.