CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Frye Regional Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $880
Cash Discount Price: $1,683
vs. Medicare Baseline: 0.95x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Frye Regional Medical Center is $880. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,683. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.95x the Medicare baseline. Located in 420 N Center St, Hickory, NC.

Cash / Self-Pay

$1,683

Average discount available for prompt cash payment at this facility.

Insurance Median

$880

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: $1,683 (182%)

Insurance Median: $880 (95%)

Cash: $1,683 (182% of Medicare)

Ins. Median: $880 (95% 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
UnitedHealthcare	$414 - $5,073	45%
Aetna	$440 - $898	47%
Blue Cross Blue Shield	$542 - $778	58%
Vaya Health	$542	58%
Partners Health Management	$552	60%
Amerihealth Caritas North Carolina	$553	60%
Carolina Complete Health Inc.	$745	80%
Veteran Family Member Program	$819	88%
Humana	$880	95%
Sherrill Furniture	$928	100%
Wellcare Of North Carolina, Inc	$947	102%
Vanguard Furniture	$956	103%
Cigna	$1,067 - $1,109	115%
Ambetter / Centene	$1,444	156%

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 $1,683.
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 Frye 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.