CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Cannon Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $131
Cash Discount Price: $151
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Cannon Memorial Hospital is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $151. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.14x the Medicare baseline. Located in 123 W G Acker Drive, Pickens, SC.

Cash / Self-Pay

$151

Average discount available for prompt cash payment at this facility.

Insurance Median

$131

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: $151 (16%)

Insurance Median: $131 (14%)

Cash: $151 (16% of Medicare)

Ins. Median: $131 (14% 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
Medicaid / KanCare	$91 - $118	10%
Absolute Total Care [58]	$93 - $120	10%
Humana	$96 - $883	10%
Select Health Of Sc [637]	$96 - $105	10%
Aetna	$125 - $200	13%
Blue Choice Health Plan [922]	$125 - $336	13%
Blue Cross Blue Shield	$125 - $336	13%
Devoted Health Alt Payer [9401]	$125 - $127	13%
Devoted Health [94]	$125 - $127	13%
Medicare (plans)	$125 - $143	13%
UnitedHealthcare	$125 - $224	13%
Vaccn - Va Community Care Network [16]	$125	13%
Veterans Administration [633]	$125	13%
Cigna	$128 - $241	14%
Molina Dual Options Alt Payer [1501]	$128	14%
Molina Dual Options [15]	$128	14%
Absolute Total Care Mcr Plans Alt Payer [4101]	$129	14%
Absolute Total Care Mcr Plans [41]	$129	14%
Champva [604]	$131	14%
First Choice Vip Careplus Alt Payer [3301]	$131	14%
First Choice Vip [33]	$131	14%
Nhc Advantage Alt Payer [6101]	$131	14%
Nhc Advantage [61]	$131	14%
Tricare	$131	14%
Bright Health Alt Payer [1001]	$133 - $143	14%
Ambetter / Centene	$178	19%
Bright Health [11]	$178	19%
First Choice Next [96]	$181	20%
Molina Marketplace [97]	$181	20%
Mail Handlers Benefit Plan [327]	$200	22%
Rural Carrier Benefit Plan [406]	$200	22%
Workers Compensation [622]	$202	22%
Edison Health Solutions [95]	$218	24%
Healthscope [98]	$218	24%
Geha [302]	$224	24%
Golden Rule Ins Co [584]	$224	24%
Nalc Health Benefit Plan [291]	$241	26%
Employee Benefit Management Services [869]	$279	30%
Medcost [206]	$284	31%
Planned Administrators [886]	$336	36%
Thomas Cooper & Company [315]	$336	36%
Preferred Administrators [19]	$349	38%
Phcs [940]	$511	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 $151.
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 Cannon Memorial 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.