CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Mount Carmel St Ann's

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $3,416
Cash Discount Price: $3,870
vs. Medicare Baseline: 3.69x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Mount Carmel St Ann's is $3,416. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,870. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 3.69x the Medicare baseline. Located in 500 South Cleveland Avenue, Westerville, OH.

Cash / Self-Pay

$3,870

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,416

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: $3,870 (418%)

Insurance Median: $3,416 (369%)

Cash: $3,870 (418% of Medicare)

Ins. Median: $3,416 (369% 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 369% of the Medicare baseline (a markup of 269%). 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
Crime Victim Assistance	$632	68%
Ohio Safe Program	$632	68%
Medicare (plans)	$1,627 - $1,943	176%
Aetna	$1,813 - $3,698	196%
Blue Cross Blue Shield	$1,813 - $6,902	196%
Hospice Mount Carmel	$1,850	200%
UnitedHealthcare	$1,850 - $6,061	200%
The Health Plan	$1,887	204%
Oscar	$3,053	329%
American Postal Workers Secondary	$3,262	352%
Cigna	$3,262	352%
Health Partners	$3,262	352%
Healthgram	$3,262	352%
Mvp	$3,262	352%
Priority Health	$3,262	352%
Enterprise Group Planning	$3,571	385%
Rural Carrier Health Benefit Plan	$3,698	399%
Custom Design Benefits	$3,867	417%
Quality Care Partners	$4,182	451%
Medical Mutual	$4,547 - $6,583	491%
Geha	$6,061	654%
Western & Southern Financial Group	$6,583	710%
Blue Benefit Administrators Of Massachusetts	$6,902	745%
Blue Care Network	$6,902	745%
Blue Distinction Transplant	$6,902	745%
Blue Shield - Ca	$6,902	745%
Blue Shield - Id (Regence)	$6,902	745%
Blue Shield - Ny Highmark Northeastern	$6,902	745%
Blue Shield - Ny Highmark Western	$6,902	745%
Blue Shield - Pa (Highmark)	$6,902	745%
Blue Shield - Wa (Regence)	$6,902	745%

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 $3,870.
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 Mount Carmel St Ann's 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.