CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Cincinnati Children's Hospital Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $666
Cash Discount Price: $554
vs. Medicare Baseline: 0.72x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Cincinnati Children's Hospital Medical Center is $666. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $554. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.72x the Medicare baseline. Located in 3333 Burnet Avenue, Cincinnati, OH.

Cash / Self-Pay

$554

Average discount available for prompt cash payment at this facility.

Insurance Median

$666

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: $554 (60%)

Insurance Median: $666 (72%)

Cash: $554 (60% of Medicare)

Ins. Median: $666 (72% 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
Blue Cross Blue Shield	$125 - $1,086	13%
Caresource_Oh	$125 - $147	13%
Humana	$125 - $188	13%
Amerihealth_Caritas_Oh	$128 - $151	14%
Molina_Oh	$131 - $154	14%
Aetna	$134 - $1,086	14%
Buckeye_Oh	$137 - $161	15%
Wellcare_Ky	$141 - $188	15%
United_Health_Care_Ky	$142 - $189	15%
United_Health_Care_Oh	$149 - $175	16%
Passport_Ky	$186	20%
Caresource_In	$222 - $296	24%
Caresource_Oh_Insurance	$543	59%
Medical_Mutual_Of_Ohio_Insurance	$582 - $988	63%
Parkview_Signature_Care_Insurance	$666 - $783	72%
Point_Comfort_Insurance	$706	76%
Margaret_Mary_Health_Insurance	$720 - $847	78%
Cigna	$738 - $869	80%
Health_Ohio_Network_Insurance	$869 - $1,032	94%
Beechstreet_Insurance	$877 - $1,032	95%
Private_Health_Care_Systems_Insurance	$965	104%
United_Health_Care_Insurance	$969 - $1,086	105%
Evolutions_Health_Care_Systems	$977	105%
Galaxy_Health_Insurance	$977	105%
Custom_Design_Benefits_Insurance	$1,032	111%
First_Health_Group_Insurance	$1,032	111%
Health_Link_Insurance	$1,032	111%
Health_Smart_Preferred_Insurance	$1,032	111%
Medical_Benefit_Administrators_Insurance	$1,032	111%
Ohio_Health_Choice_Insurance	$1,032	111%

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 $554.
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 Cincinnati Children's Hospital 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.