CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Christ Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $866
Cash Discount Price: $3,608
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Christ Hospital is $866. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,608. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.93x the Medicare baseline. Located in 2139 Auburn Avenue, Cincinnati, OH.

Cash / Self-Pay

$3,608

Average discount available for prompt cash payment at this facility.

Insurance Median

$866

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: $3,608 (389%)

Insurance Median: $866 (93%)

Cash: $3,608 (389% of Medicare)

Ins. Median: $866 (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
UnitedHealthcare	$73 - $4,982	8%
Blue Cross Blue Shield	$602 - $3,471	65%
Caresource [2031]	$602 - $5,852	65%
Humana	$602 - $6,538	65%
Medicaid / KanCare	$602 - $2,779	65%
Aetna	$866 - $4,589	93%
Allied Benefits [2163]	$866	93%
Ambetter / Centene	$866	93%
Buckeye Mycare Dual [2171]	$866	93%
Cigna	$866	93%
Custom Design Benefits - True Cost [3004]	$866	93%
First Health [2041]	$866	93%
Medben [2222]	$866	93%
Medicare (plans)	$866	93%
Medigold Ppo [2204]	$866	93%
Meridian [2185]	$866	93%
Meritain Health [2224]	$866	93%
Other Exchange Plan [9992]	$866	93%
Perennial [4200]	$866	93%
Poppins Health [2299]	$866	93%
Medical Mutual [2054]	$2,552	275%
Western And Southern [2076]	$2,552	275%
Life Synch [2080]	$3,608	389%
Amerihealth Caritas [2230]	$4,633	500%
Geha [2168]	$4,982	538%
Golden Rule [2161]	$4,982	538%
United Medical Resources [2104]	$4,982	538%
Buckeye Community Health [2028]	$9,311	1005%

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 $3,608.
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 Christ Hospital 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.