CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Southern Ocean Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $3,106
Cash Discount Price: $1,025
vs. Medicare Baseline: 3.35x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Southern Ocean Medical Center is $3,106. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,025. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 3.35x the Medicare baseline. Located in 1140 Rt 72 W, Manahawkin, NJ.

Cash / Self-Pay

$1,025

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,106

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: $1,025 (111%)

Insurance Median: $3,106 (335%)

Cash: $1,025 (111% of Medicare)

Ins. Median: $3,106 (335% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 335% of the Medicare baseline (a markup of 235%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Karna	$282	30%
Clover	$739	80%
Aetna	$760 - $9,383	82%
Seoul Medical Group	$842	91%
Blue Cross Blue Shield	$1,025	111%
Vaccn	$1,025	111%
Wellcare	$1,025	111%
United Community/Americhoice	$1,076	116%
Horizon	$1,188 - $3,754	128%
UnitedHealthcare	$1,189 - $7,601	128%
Qualcare	$1,982 - $3,728	214%
Bergen Risk	$3,080	332%
Cigna	$3,133 - $3,508	338%
Multiplan - PHCS	$3,490	377%
Amerihealth	$3,566 - $4,039	385%
Oxford	$6,189	668%
Brighton Health Plan	$9,933	1072%

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 $1,025.
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 Southern Ocean 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.