CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: East Liverpool City Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 43239
  • Insurance Median: $854
  • Cash Discount Price: $853
  • vs. Medicare Baseline: 0.92x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at East Liverpool City Hospital is $854. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $853. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.92x the Medicare baseline. Located in 425 West 5Th Street, East Liverpool, OH.
Cash / Self-Pay
$853

Average discount available for prompt cash payment at this facility.

Insurance Median
$854

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: $853 (92%)
Insurance Median: $854 (92%)
Cash: $853 (92% of Medicare)
Ins. Median: $854 (92% 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.

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
Buckeye Community Health Plan $235 - $1,251 25%
Medicaid / KanCare $235 25%
Molina $235 - $1,238 25%
Standard Eapg Logic $235 25%
Care Source $239 - $1,238 26%
Blue Cross Blue Shield $242 - $854 26%
Paramount $242 26%
Amerihealth Caritas $246 27%
UnitedHealthcare $246 - $854 27%
Health America $854 92%
Medical Mutual Of Oh $854 92%
Medicare (plans) $854 92%
Tricare $854 92%
Devoted Health $897 97%
Communicare $914 99%
Valor Health Plan $914 99%
Perennial $939 101%
Naphcare $1,025 111%
Employer Direct Healthcare $1,195 129%
Three Rivers $1,240 134%
Multiplan (Fka Private Healthcare Systems) $1,251 135%
Provider Select $1,251 135%
Worker Compensation $1,251 135%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 425 West 5Th Street, East Liverpool, OH 43920
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals