CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Prisma Health Greer Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,208
Cash Discount Price: $1,793
vs. Medicare Baseline: 1.30x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Prisma Health Greer Memorial Hospital is $1,208. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,793. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.30x the Medicare baseline. Located in 1413 John B White Sr Blvd Suite D, Spartanburg, SC.

Cash / Self-Pay

$1,793

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,208

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: $1,793 (193%)

Insurance Median: $1,208 (130%)

Cash: $1,793 (193% of Medicare)

Ins. Median: $1,208 (130% 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 Choice Healthplan Of Sc	$214 - $1,780	23%
Medicaid / KanCare	$233 - $1,912	25%
Bluechoice Healthplan Of Sc	$242 - $3,275	26%
Molina	$247 - $1,876	27%
Select Health	$247 - $1,876	27%
Humana	$249 - $1,949	27%
Tricare	$349 - $795	38%
Choicecare Network	$356 - $2,345	38%
Medicare (plans)	$451 - $834	49%
Wellpath Select Inc	$479 - $1,090	52%
Sc Workers Compensation	$488 - $1,112	53%
Prisma Health Seniorcare Pace-Upstate	$665	72%
Celtic Insurance Company	$779	84%
Veterans Administration	$795	86%
Blue Cross Blue Shield	$810 - $3,121	87%
Cigna	$821 - $2,207	89%
Liberty Advantage	$821	89%
UnitedHealthcare	$822 - $4,023	89%
Promise Health Plan	$823	89%
Absolute Total Care Prime	$834	90%
Aetna	$834 - $2,428	90%
Windsor Health Plan	$834	90%
Value Options	$1,380	149%
Preferred Care, Inc	$1,931	208%
Chp Direct Supermed Network	$1,986	214%
Medcost	$2,042	220%
Atlantic Packaging	$2,069	223%
Aps Healthcare Bethesda Inc	$2,207	238%
Medcost Preferred	$2,262	244%
Multiplan	$2,456	265%
Companion Benefit Alternatives	$2,759	298%
Miscellaneous	$2,759	298%
Self Pay	$2,759	298%

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 $1,793.
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 Prisma Health Greer 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.