CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Coshocton Regional Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $862
Cash Discount Price: $853
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Coshocton Regional Medical Center is $862. 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 0.93x the Medicare baseline. Located in 1460 Orange Street, Coshocton, OH.

Cash / Self-Pay

$853

Average discount available for prompt cash payment at this facility.

Insurance Median

$862

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: $862 (93%)

Cash: $853 (92% of Medicare)

Ins. Median: $862 (93% 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.

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
Buckeye Community Health Plan	$230 - $1,067	25%
Care Source	$230 - $1,238	25%
Medicaid / KanCare	$230	25%
Standard Eapg Logic	$230	25%
Molina	$235 - $1,238	25%
Blue Cross Blue Shield	$237 - $854	26%
Amerihealth Caritas	$242	26%
Paramount	$242	26%
Quality Care Partner	$242	26%
UnitedHealthcare	$242 - $854	26%
Medicare (plans)	$854	92%
The Health Plan	$854	92%
Tricare	$854	92%
Med Mutual Of Oh	$871	94%
Devoted Health	$897	97%
Valor Health Plan	$914	99%
Perennial Advantage	$939	101%
Employer Direct Healthcare	$1,195	129%
Americas Choice Provider Network	$1,278	138%
Corvel	$1,278	138%
Healthsmart	$1,278	138%
Multiplan	$1,278	138%
Provider Network Of America	$1,278	138%
Provider Select	$1,278	138%
Three Rivers	$1,278	138%
Workers Compensation	$1,278	138%

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 $853.
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 Coshocton Regional 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.