CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Oklahoma Heart Hospital South, LLC

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,032
Cash Discount Price: $5,421
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Oklahoma Heart Hospital South, LLC is $1,032. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,421. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.11x the Medicare baseline. Located in 5200 East I-240 Service Road, Oklahoma City, OK.

Cash / Self-Pay

$5,421

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,032

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: $5,421 (585%)

Insurance Median: $1,032 (111%)

Cash: $5,421 (585% of Medicare)

Ins. Median: $1,032 (111% 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
Healthcare Highways	$374 - $897	40%
Healthscope	$688	74%
Oscar Insurance Company	$688	74%
Webtpa Chickasaw Nation Hch	$703	76%
Webtpa Hobby Lobby Hch	$792	85%
Aetna	$817 - $1,078	88%
Humana	$817 - $1,078	88%
Blue Cross Blue Shield	$872 - $1,772	94%
Cigna	$872 - $1,047	94%
Medicare (plans)	$872 - $898	94%
UnitedHealthcare	$872 - $927	94%
Va Ccn	$872	94%
Geha	$927	100%
Global Health	$942	102%
Sana Benefits	$972	105%
Ufcw	$972	105%
First Health Network	$1,032	111%
Manhattan Life	$1,032	111%
Community Care	$1,047 - $1,745	113%
Phcs	$1,047	113%
Preferred Community Choice	$1,136	123%
Ambetter / Centene	$1,221	132%
Multiplan	$1,346	145%
Coventry	$1,532	165%
The Kempton Group	$2,181	235%

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 $5,421.
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 Oklahoma Heart Hospital South, LLC 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.