CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Caromont Regional Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,447
Cash Discount Price: $3,702
vs. Medicare Baseline: 1.56x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Caromont Regional Medical Center is $1,447. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,702. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.56x the Medicare baseline. Located in 2525 Court Dr, Gastonia, NC.

Cash / Self-Pay

$3,702

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,447

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: $3,702 (400%)

Insurance Median: $1,447 (156%)

Cash: $3,702 (400% of Medicare)

Ins. Median: $1,447 (156% 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
Blue Cross Blue Shield	$440 - $1,643	47%
Carolina Complete Health	$440 - $597	47%
Partners Behavioral Health	$440 - $597	47%
Alliance Behavioral Health	$449 - $609	48%
Amerihealth Caritas	$449 - $609	48%
Carolina Complete Health Tailored Plans	$449 - $609	48%
UnitedHealthcare	$449 - $6,824	48%
Vaya Behavioral Health	$449 - $609	48%
Wellcare	$449 - $609	48%
Gaston County Jail	$880 - $1,194	95%
Aetna	$964 - $1,964	104%
Devoted Health	$973	105%
Healthteam	$973	105%
Longevity Health	$973	105%
Molina	$973 - $1,270	105%
Humana	$991 - $3,492	107%
Absolute Total Care	$1,270	137%
Surgery Plus	$1,622	175%
Cigna	$1,724 - $2,669	186%
Self Pay	$1,900 - $2,579	205%
Medcost	$1,909 - $2,517	206%
Carolina Caring	$2,315 - $3,143	250%
Beech Street	$2,397 - $3,254	259%
Multiplan	$2,397 - $3,254	259%
Corporate Benefits Service	$2,493	269%
First Health Network	$2,777 - $3,770	300%

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 $3,702.
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 Caromont Regional 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.