CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Nationwide Children's Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $512
Cash Discount Price: $615
vs. Medicare Baseline: 0.55x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Nationwide Children's Hospital is $512. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $615. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.55x the Medicare baseline. Located in 700 Children's Drive, Columbus, OH.

Cash / Self-Pay

$615

Average discount available for prompt cash payment at this facility.

Insurance Median

$512

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: $615 (66%)

Insurance Median: $512 (55%)

Cash: $615 (66% of Medicare)

Ins. Median: $512 (55% 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
Amerihealth	$296 - $1,199	32%
Bchp	$296 - $1,199	32%
Blue Cross Blue Shield	$296 - $1,199	32%
Caresource	$296 - $1,390	32%
Humana	$296 - $1,199	32%
Molina	$296 - $1,199	32%
UnitedHealthcare	$296 - $1,199	32%
Tricare	$317 - $880	34%
Aetna	$486 - $512	52%
Mmo	$492	53%
Cigna	$512	55%
Front Path Health Coalition	$512	55%
Ohc	$512	55%
Ohg	$512	55%
Ohio Ppo Connect	$512	55%
Osu	$512	55%
The Health Plan	$512	55%

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 $615.
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 Nationwide Children's 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.