Upper endoscopy with biopsy
Facility: Physicians Care Surgical Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $2,311
- Cash Discount Price: $5,439
- vs. Medicare Baseline: 2.49x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 249% of the Medicare baseline (a markup of 149%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Humana | $537 - $12,772 | 58% |
| Tricare | $537 - $12,772 | 58% |
| Aarp | $826 - $12,772 | 89% |
| Aetna | $826 - $23,230 | 89% |
| Blue Cross Blue Shield | $826 - $23,941 | 89% |
| Cigna | $826 - $18,977 | 89% |
| Devon Health Services | $826 - $12,772 | 89% |
| Gpm Health And Life Insurance Mc Supplement | $826 - $12,772 | 89% |
| Ibc Security 65 | $826 - $12,363 | 89% |
| Keystone 65 Hmo | $826 - $12,772 | 89% |
| Medicare (plans) | $826 - $12,772 | 89% |
| Pcsh Aarp | $826 - $12,772 | 89% |
| Personal Choice 65 | $826 - $12,363 | 89% |
| Shenandoah Life | $826 - $12,772 | 89% |
| Unified Health Services | $826 - $12,772 | 89% |
| UnitedHealthcare | $826 - $27,099 | 89% |
| Vibra Health Plan | $826 - $12,772 | 89% |
| Connecticare | $838 - $19,575 | 90% |
| Amerihealth Administrators | $892 - $18,753 | 96% |
| Amerihealth New Jersey Hmo | $892 - $18,753 | 96% |
| Carefirst Administrators | $892 - $18,753 | 96% |
| Empire Plan | $892 - $18,753 | 96% |
| Horizon Of New Jersey | $892 - $18,753 | 96% |
| Ibc | $892 - $18,753 | 96% |
| Ibc - Local | $892 - $18,753 | 96% |
| Ibc 2021 | $892 - $18,753 | 96% |
| Ibc Local | $892 - $18,753 | 96% |
| Independence Administrators | $892 - $18,753 | 96% |
| Independence Bc | $892 - $18,753 | 96% |
| Independence Federal | $892 - $18,753 | 96% |
| Keystone Direct Pos | $892 - $18,753 | 96% |
| Keystone Healthplan East | $892 - $18,753 | 96% |
| Keystone Hmo | $892 - $18,753 | 96% |
| Pcsh Ibc | $892 - $18,753 | 96% |
| Personal Choice | $892 - $18,753 | 96% |
| Regence Blue Shield | $892 - $18,753 | 96% |
| Keystone First | $900 - $2,850 | 97% |
| Keystone First Healthplan | $900 - $2,850 | 97% |
| Keystone First Vip Choice | $900 - $2,850 | 97% |
| Medicaid / KanCare | $900 - $2,850 | 97% |
| Pa Health And Wellness | $900 - $2,850 | 97% |
| Straight Access | $900 - $2,850 | 97% |
| Highmark | $1,599 - $23,941 | 173% |
| Allsavers | $1,751 - $27,099 | 189% |
| Golden Rule Op | $1,751 - $27,099 | 189% |
| Oxford Health Plan | $1,751 - $27,099 | 189% |
| Oxford Life Insurance Company | $1,751 - $27,099 | 189% |
| Surest | $1,751 - $27,099 | 189% |
| Upmc | $2,069 - $19,295 | 223% |
| Apwu | $2,217 - $18,977 | 239% |
| Cwi Benefits | $2,217 - $18,977 | 239% |
| Freedom Life Insurance Company | $2,217 - $18,977 | 239% |
| Health Partners | $2,217 - $18,977 | 239% |
| Healthgram | $2,217 - $18,977 | 239% |
| Loomis | $2,217 - $18,977 | 239% |
| Nalc Health | $2,217 - $18,977 | 239% |
| Sana Benefits | $2,217 - $18,977 | 239% |
| Central Pa Teamsters | $2,243 - $21,231 | 242% |
| Ag Administrators | $2,311 - $23,230 | 249% |
| Ag Administrators Inc | $2,311 - $23,230 | 249% |
| Allied Benefit Systems | $2,311 - $23,230 | 249% |
| Allied Benefits Systems | $2,311 - $23,230 | 249% |
| Continental Benefits | $2,311 - $23,230 | 249% |
| Coventry | $2,311 - $23,230 | 249% |
| Geha | $2,311 - $23,230 | 249% |
| Healthez | $2,311 - $23,230 | 249% |
| Lucent Health | $2,311 - $23,230 | 249% |
| Marpai Health | $2,311 - $23,230 | 249% |
| Meritain Health | $2,311 - $23,230 | 249% |
| Premier Care Network | $2,311 - $23,230 | 249% |
| Trustmark | $2,311 - $23,230 | 249% |