CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Columbus Regional Healthcare System

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,388
Cash Discount Price: $1,604
vs. Medicare Baseline: 1.50x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Columbus Regional Healthcare System is $1,388. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,604. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.50x the Medicare baseline. Located in 500 Jefferson St, Whiteville, NC.

Cash / Self-Pay

$1,604

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,388

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: $1,604 (173%)

Insurance Median: $1,388 (150%)

Cash: $1,604 (173% of Medicare)

Ins. Median: $1,388 (150% 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
Alliance	$512	55%
Amerihealth	$512	55%
Apex Health	$512	55%
Cardinal	$512	55%
Carolina Complete Health	$512	55%
Healthy Blue	$512	55%
Partners	$512	55%
Sandhills	$512	55%
Trillium	$512	55%
UnitedHealthcare	$512 - $1,558	55%
Wellcare	$512 - $880	55%
Molina	$588 - $1,540	63%
Blue Cross Blue Shield	$880 - $1,471	95%
Troy	$880	95%
Va Communicare Care	$880	95%
Vaya Health	$888	96%
Liberty	$897	97%
Humana	$906	98%
Aetna	$910 - $2,222	98%
Devoted Health	$915	99%
Cigna	$924 - $2,176	100%
Queens University	$1,260	136%
Ambetter / Centene	$1,333 - $1,551	144%
Oscar	$1,489 - $1,672	161%
Employers Health Network	$1,519 - $1,697	164%
Quicktrip	$1,833	198%
Multiplan	$2,062 - $2,176	223%
Choicecare	$2,176	235%
Healthgram	$2,176	235%
Medcost	$2,176	235%

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 $1,604.
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 Columbus Regional Healthcare System 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.