CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Coastal Carolina Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $886
Cash Discount Price: $833
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Coastal Carolina Hospital is $886. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $833. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.96x the Medicare baseline. Located in 1000 Medical Center Drive, Hardeeville, SC.

Cash / Self-Pay

$833

Average discount available for prompt cash payment at this facility.

Insurance Median

$886

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: $833 (90%)

Insurance Median: $886 (96%)

Cash: $833 (90% of Medicare)

Ins. Median: $886 (96% 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 Cross Blue Shield	$833 - $2,881	90%
Absolute Total Care	$844 - $1,406	91%
Aetna	$844	91%
Devoted Health	$844	91%
Humana	$844 - $1,339	91%
UnitedHealthcare	$844 - $12,403	91%
Molina	$860 - $1,392	93%
Cigna	$869	94%
Clover Insurance Company	$877	95%
Select Health	$886 - $1,611	96%

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 $833.
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 Coastal Carolina 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.