CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Highland District Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,129
Cash Discount Price: $2,714
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Highland District Hospital is $1,129. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,714. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.22x the Medicare baseline. Located in 1275 North High Street, Hillsboro, OH.

Cash / Self-Pay

$2,714

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,129

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: $2,714 (293%)

Insurance Median: $1,129 (122%)

Cash: $2,714 (293% of Medicare)

Ins. Median: $1,129 (122% 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
Highland_County_Sheriff_Dept	$481	52%
Medicaid / KanCare	$481 - $505	52%
Blue Cross Blue Shield	$495 - $4,917	53%
Humana	$495 - $3,005	53%
Medicare (plans)	$1,085 - $1,118	117%
UnitedHealthcare	$1,085	117%
Aetna	$1,107 - $2,754	119%
Medigold	$1,140	123%
Immergrun_Amish	$2,714	293%
Medben	$2,714	293%
Central_Benefits_Commercial	$3,053	329%
Cigna	$3,053	329%
Medical_Mutual_Commercial	$3,087	333%
Uhc_	$3,121	337%

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 $2,714.
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 Highland District 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.