CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Genesis Hospital
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $2,001
- Cash Discount Price: $4,901
- vs. Medicare Baseline: 2.16x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Genesis Hospital is $2,001. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,901. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.16x the Medicare baseline. Located in 2951 Maple Avenue, Zanesville, OH.
Cash / Self-Pay
$4,901
Average discount available for prompt cash payment at this facility.
Insurance Median
$2,001
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: $4,901 (529%)
Insurance Median: $2,001 (216%)
Cash: $4,901 (529% of Medicare)
Ins. Median: $2,001 (216% 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 216% of the Medicare baseline (a markup of 116%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Fulton County Health Department [1013223] | $66 - $656 | 7% |
| Noble County Health Department [10017599] | $66 - $656 | 7% |
| Ou Comm Hlth Prog Ouhcom Hap Bsp [101321] | $66 - $656 | 7% |
| Trinity Bccp [101328] | $66 - $656 | 7% |
| Bwc Pending Enablecomp [100544] | $121 | 13% |
| Generic Workers' Comp [10051] | $121 | 13% |
| Mco 3 Hab [100522] | $121 | 13% |
| Mco Advocare [100525] | $121 | 13% |
| Mco Aultcomp [100526] | $121 | 13% |
| Mco Careworks Of Ohio [100122] | $121 | 13% |
| Mco Comp Management Health [100123] | $121 | 13% |
| Mco Comp One [100527] | $121 | 13% |
| Mco Conduent [100545] | $121 | 13% |
| Mco Corvel Group [100124] | $121 | 13% |
| Mco Frank Gates Managed Care [100528] | $121 | 13% |
| Mco Gates Mcdonald [100125] | $121 | 13% |
| Mco Genex Care Of Ohio [100529] | $121 | 13% |
| Mco Hunter Consulting [100546] | $121 | 13% |
| Mco Minute Men Ohiocomp [100524] | $121 | 13% |
| Mco Occupational Health Link, Inc [100521] | $121 | 13% |
| Mco Promedica Medical Mgmt [100531] | $121 | 13% |
| Mco Sedgwick [100206] | $121 | 13% |
| Mco Sheakley Unicare [100127] | $121 | 13% |
| Mco The Health Plan [100176] | $121 | 13% |
| Mco Transportation Claims [100547] | $121 | 13% |
| Mco Travelers Insurance [100548] | $121 | 13% |
| Mco University Hospitals Compcare [100532] | $121 | 13% |
| Mco Workstar Health Srv [100533] | $121 | 13% |
| Spooner Medical Administrators Inc [100126] | $121 | 13% |
| Wc 888 Ohio Comp Lchn [100535] | $121 | 13% |
| Wc Ak Steel Zanesville [10055] | $121 | 13% |
| Wc Avizent Workers Comp [10052] | $121 | 13% |
| Wc Broadspire [100540] | $121 | 13% |
| Wc Bunch & Associates [100537] | $121 | 13% |
| Wc Careworks Consultant [10057] | $121 | 13% |
| Wc Comp Services [10056] | $121 | 13% |
| Wc Compmanagement Inc [10058] | $121 | 13% |
| Wc Constitution State [10059] | $121 | 13% |
| Wc Dollar General Corp [100510] | $121 | 13% |
| Wc Esis 3700 [100538] | $121 | 13% |
| Wc Frank Gates [100541] | $121 | 13% |
| Wc Gallagher Bassett [10053] | $121 | 13% |
| Wc Genesis Hcs Workers Comp [10054] | $121 | 13% |
| Wc Helmsman Management Srv [100536] | $121 | 13% |
| Wc Kroger Co [100512] | $121 | 13% |
| Wc Lear Corp [100513] | $121 | 13% |
| Wc Longaberger [100514] | $121 | 13% |
| Wc Ohio Bwc Black Lung [100534] | $121 | 13% |
| Wc Owen Brockway [100515] | $121 | 13% |
| Wc Pepsi Cola [100539] | $121 | 13% |
| Wc Sedgwick Of Ohio [100516] | $121 | 13% |
| Wc Us Department Of Labor Black Lung Prog [100542] | $121 | 13% |
| Wc Us Post Office [100517] | $121 | 13% |
| Wc Walmart Claims [100518] | $121 | 13% |
| Wc Zandex [100519] | $121 | 13% |
| Molina Marketplace [100203] | $828 - $1,661 | 89% |
| Aetna | $946 - $3,692 | 102% |
| American Trust Adm [100196] | $946 - $2,001 | 102% |
| Antidote Healthplan [111121] | $946 - $2,001 | 102% |
| Aultcare [10019] | $946 - $7,260 | 102% |
| Aultra [10026] | $946 - $2,001 | 102% |
| Blue Cross Blue Shield | $946 - $6,292 | 102% |
| Cambridge Behavioral Hospital [10011219] | $946 - $2,001 | 102% |
| Caresource Marketplace [100204] | $946 - $2,001 | 102% |
| Department Of Veterans Affairs [100702] | $946 - $2,001 | 102% |
| Ebmc [100119] | $946 - $3,487 | 102% |
| Employee Benefits [100120] | $946 - $4,981 | 102% |
| Genesis Medical Benefits Alternate [99910012801] | $946 - $2,001 | 102% |
| Healthypath [111117] | $946 - $2,001 | 102% |
| Humana | $946 - $2,001 | 102% |
| Luminare Health [111116] | $946 - $2,001 | 102% |
| Medical Benefits [100128] | $946 - $3,487 | 102% |
| Medicare (plans) | $946 - $2,001 | 102% |
| Medova [1001177] | $946 - $2,001 | 102% |
| Mid America Associates, Inc. [1001176] | $946 - $2,001 | 102% |
| Ngs American [100130] | $946 - $2,001 | 102% |
| Ohio Ppo Connect [1001142] | $946 - $2,001 | 102% |
| Qcp Plus [1001143] | $946 - $2,001 | 102% |
| Qcp [100133] | $946 - $2,001 | 102% |
| Trustmark [1001134] | $946 - $3,692 | 102% |
| Umwa [101329] | $946 - $2,001 | 102% |
| UnitedHealthcare | $946 - $3,398 | 102% |
| Valor Healthplan [111114] | $946 - $2,001 | 102% |
| Wellcare [11101] | $946 - $2,001 | 102% |
| Omas Amish Fund (Oh Medical Aid Services) [111118] | $1,844 - $3,902 | 199% |
| Valley View Health Clinic [111126] | $1,844 - $3,902 | 199% |
| Medical Mutual Marketplace [111107] | $2,765 | 298% |
| Select Specialty Hosp Of Se Oh (Alternate) [9991013222] | $3,247 | 350% |
| Select Specialty Hospital Of Southeast Ohio [1013222] | $3,247 | 350% |
| Compass Rose Health Plan [10011209] | $3,398 | 367% |
| United Medical Resources [100153] | $3,398 | 367% |
| Allied Benefit [100193] | $3,431 - $7,260 | 370% |
| Apwu [100197] | $3,431 - $7,260 | 370% |
| Bac [1001100] | $3,431 - $7,260 | 370% |
| Boilermaker [1001101] | $3,431 - $7,260 | 370% |
| Cigna | $3,431 - $7,260 | 370% |
| Connecticut General Life Ins [10011214] | $3,431 - $7,260 | 370% |
| Enterprise Group Planning [1001171] | $3,431 - $7,260 | 370% |
| Federated Insurance [10011213] | $3,431 - $7,260 | 370% |
| Gms [1001175] | $3,431 - $7,260 | 370% |
| Health Partners [10011200] | $3,431 - $7,260 | 370% |
| Healthscope [100117] | $3,431 - $7,260 | 370% |
| Healthsmart Benefit Solutions [1001161] | $3,431 - $7,260 | 370% |
| Nalc [10024] | $3,431 - $7,260 | 370% |
| Benefit Services [100114] | $3,487 | 376% |
| Central States [100118] | $3,487 | 376% |
| Ebs Of Ohio [1001108] | $3,487 | 376% |
| Ibew Local [1001168] | $3,487 | 376% |
| Mmo [100129] | $3,487 | 376% |
| Mutual Health Services [10011205] | $3,487 | 376% |
| Reserve National [1001128] | $3,487 | 376% |
| Self Funded Plans [100134] | $3,487 | 376% |
| Upmc Health Plan [10011202] | $3,487 | 376% |
| Western Southern Financial Group [100190] | $3,487 | 376% |
| Assurant Health [100198] | $3,692 | 398% |
| Chesterfield Resources [1001166] | $3,692 | 398% |
| Coventry Health Care [1001106] | $3,692 | 398% |
| Employee Benefit Management Services [1001163] | $3,692 | 398% |
| Generic Meritain [1001119] | $3,692 | 398% |
| Healthsmart Payors Organization [1001116] | $3,692 | 398% |
| Meritain [1001118] | $3,692 | 398% |
| Nippon Life Benefits [1001169] | $3,692 | 398% |
| Starmark [1001130] | $3,692 | 398% |
| Healthplan Upper Ohio Valley [10017] | $4,571 | 493% |
| Thp Insurance Company [10045] | $4,571 | 493% |
| Woodmen Assured Life [100171] | $4,571 | 493% |
| Generic Usa Network [1001114] | $4,981 | 538% |
| Key Benefit Administrators Inc [10011207] | $4,981 | 538% |
| Multiplan [1001120] | $4,981 | 538% |
| Ohio Healthy [1001179] | $4,981 | 538% |