Upper endoscopy with biopsy
Facility: Prisma Health Tuomey Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,178
- Cash Discount Price: $1,901
- vs. Medicare Baseline: 1.27x 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.
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 |
|---|---|---|
| Medicaid / KanCare | $450 - $1,743 | 49% |
| UnitedHealthcare | $450 - $6,939 | 49% |
| Prisma Health Seniorcare Pace - Midlands [5400] | $679 | 73% |
| Prisma Health Seniorcare Pace-Upstate [5200] | $679 | 73% |
| Blue Cross Blue Shield | $772 - $848 | 83% |
| Bluechoice [810] | $772 - $3,246 | 83% |
| Planned Administrators [820] | $772 | 83% |
| Scdc-Sc Dept Of Corrections [7232] | $833 | 90% |
| Cigna | $848 - $2,243 | 92% |
| Covid19 Hrsa Uninsured Testing & Treatment Fund [904] | $848 | 92% |
| Humana | $848 - $2,194 | 92% |
| Medicare (plans) | $848 - $890 | 92% |
| Triwest Healthcare Alliance Vcp [902] | $848 | 92% |
| Va Community Care Network-Vaccn [903] | $848 | 92% |
| Tricare | $878 | 95% |
| Aetna | $890 - $2,311 | 96% |
| Healthy Conn Prime-First Choice Vip Care [5300] | $890 | 96% |
| Healthy Conn Prime-Molina Healthcare [5330] | $890 | 96% |
| Healthy Conn Prime-Wellcare Prime By Atc [5310] | $890 | 96% |
| Promise Health Plan Contracted [2401] | $1,024 - $1,755 | 111% |
| Orangeburg Senior Helping Center Pace [5401] | $1,170 | 126% |
| Workers Comp [600] | $1,187 | 128% |
| Ambetter / Centene | $1,560 | 168% |
| Bob Jones Univ-Pai [821] | $1,755 | 189% |
| Meritain Health Contracted [2200] | $1,872 - $2,311 | 202% |
| Preferred Administrators Contracted [2839] | $2,048 | 221% |
| Medcost [2940] | $2,164 - $2,428 | 234% |
| Atlantic Packaging Contracted [4833] | $2,194 | 237% |
| Aps Healthcare System [2981] | $2,340 | 253% |
| Multiplan/Phcs Contracted [2950] | $2,603 | 281% |
| Vsp Vision Care [2986] | $2,632 | 284% |
| First Health Contracted [2952] | $2,720 | 294% |
| Furman Int/Allen University Student [2951] | $2,720 | 294% |
| Quiktrip-First Health [3067] | $2,720 | 294% |
| Golden Rule Insurance Company [2991] | $6,939 | 749% |
| Oxford Health Plans [2992] | $6,939 | 749% |
| Zzumr-Salt Lake City Ut [3169] | $6,939 | 749% |