CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Southern Ohio Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$428

about 0.5× the $927 Medicare rate · typically $181–$828

modeled estimate · not a bill or quote

What this hospital charges insurers

$181

Below the fair price — a good deal

about $247 under the fair price · 0.2× Medicare

Medicare pays $927 Fair price $428 This hospital $181 Cash price $275 Hospital's list price $550

How we calculate the fair BaseRate →

How this hospital compares to other OH hospitals

One of the lower prices — 6 of 8 other OH hospitals charge more for the same procedure.

Cheapest $175 Priciest $499

Black dot = this hospital, among the 9 OH hospitals with a price for this procedure. Full list below.

A fair price for a Upper endoscopy with biopsy is about $428 (about 0.5× the $927 Medicare rate). Southern Ohio Medical Center charges insurers about $181, or about $275 in cash — below the fair price — a good deal. Located in Portsmouth, OH.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$147 - $484	16%
Blue Cross Blue Shieldmajor	$140 - $866	15%
Aetnamajor	$262 - $858	28%
Cignamajor	$236 - $456	25%
Humanamajor	$179 - $866	19%
Ambetter (Centene)	$129	14%
CareSource	$155 - $1,169	17%
Medical Mutual	$129 - $451	14%
Molina	$129 - $1,040	14%
WellCare	$129 - $181	14%
+ 6 smaller / regional plans	$129 - $1,213

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 275), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Southern Ohio Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Southern Ohio Medical Center

Compare: Upper endoscopy with biopsy at other OH hospitals

Insurance negotiated median for the same procedure, sorted lowest first.