CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Carolina East Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,287
Cash Discount Price: $1,316
vs. Medicare Baseline: 1.39x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Carolina East Medical Center is $1,287. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,316. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.39x the Medicare baseline. Located in 2000 Neuse Blvd, New Bern, NC.

Cash / Self-Pay

$1,316

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,287

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: $1,316 (142%)

Insurance Median: $1,287 (139%)

Cash: $1,316 (142% of Medicare)

Ins. Median: $1,287 (139% 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	$118 - $867	13%
Inclusive Health (Nchirp)-All Plans	$118 - $867	13%
Tricare	$118 - $2,932	13%
Pamlico Co Jail-All Plans	$387 - $780	42%
UnitedHealthcare	$509 - $2,085	55%
Craven Co. Jail Systems - All Plans	$510 - $988	55%
Medcost Ppo Employees And Retirees	$955 - $1,925	103%
Medcost Ppo Ultra (Employees)	$955 - $1,834	103%
Blue Cross Blue Shield	$1,015 - $2,011	110%
Medcost Ppo City Employees	$1,059 - $2,136	114%
Medcost Ppo County Employee	$1,101 - $2,221	119%
Benefit Mgmt, Svcs-All Plans	$1,236 - $2,492	133%
Medcost Benefit Svc-All Other Plans	$1,285 - $2,591	139%
Aetna	$1,288 - $2,598	139%
Acs Consult Svc Inc-All Plans	$1,313 - $2,648	142%
Medcost Ppo Standard	$1,313 - $2,648	142%
Cigna	$1,323 - $2,668	143%

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 $1,316.
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 Carolina East 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.