CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Prisma Health Patewood Hospital
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $987
- Cash Discount Price: $1,901
- vs. Medicare Baseline: 1.07x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Prisma Health Patewood Hospital is $987. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,901. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.07x the Medicare baseline. Located in 175 Patewood Drive, Greenville, SC.
Cash / Self-Pay
$1,901
Average discount available for prompt cash payment at this facility.
Insurance Median
$987
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: $1,901 (205%)
Insurance Median: $987 (107%)
Cash: $1,901 (205% of Medicare)
Ins. Median: $987 (107% 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
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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 - $2,179 | 49% |
| UnitedHealthcare | $450 - $4,399 | 49% |
| Prisma Health Seniorcare Pace - Midlands [5400] | $679 | 73% |
| Prisma Health Seniorcare Pace-Upstate [5200] | $679 | 73% |
| Blue Cross Blue Shield | $833 - $3,439 | 90% |
| Sc Dept Of Corrections [2998] | $833 | 90% |
| Scdc-Sc Dept Of Corrections [7232] | $833 | 90% |
| Champva [3049] | $865 | 93% |
| Cigna | $865 - $2,030 | 93% |
| Covid19 Hrsa Uninsured Testing & Treatment Fund [904] | $865 | 93% |
| Deseret Mutual Ins Co [3066] | $865 | 93% |
| Generic Skilled Nursing [3196] | $865 | 93% |
| Hospice Contracted [1500] | $865 | 93% |
| Hospice Non Contracted [3190] | $865 | 93% |
| Medicare (plans) | $865 - $2,049 | 93% |
| Triwest Healthcare Alliance Vcp [902] | $865 | 93% |
| Va Community Care Network-Vaccn [903] | $865 | 93% |
| Veterans Administration [3194] | $865 | 93% |
| Tricare | $872 | 94% |
| Humana | $882 - $2,221 | 95% |
| Aetna | $908 - $2,311 | 98% |
| Healthy Conn Prime-Wellcare Prime By Atc [5310] | $908 | 98% |
| Healthy Conn Prime-First Choice Vip Care [5300] | $916 | 99% |
| Healthy Conn Prime-Molina Healthcare [5330] | $951 | 103% |
| Promise Health Plan Contracted [2401] | $1,024 - $1,755 | 111% |
| Orangeburg Senior Helping Center Pace [5401] | $1,170 | 126% |
| Workers Comp [600] | $1,210 | 131% |
| Bluechoice [810] | $1,539 - $3,585 | 166% |
| Ambetter / Centene | $1,591 | 172% |
| Bob Jones Univ-Pai [821] | $1,755 | 189% |
| Meritain Health Contracted [2200] | $1,872 - $2,311 | 202% |
| Evernorth Behavioral Contracted [2982] | $2,030 | 219% |
| Mvp Health Care [3037] | $2,030 | 219% |
| Preferred Administrators Contracted [2839] | $2,048 | 221% |
| First Choice Benefits Mgmt [3074] | $2,049 | 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% |
| Planned Administrators [820] | $3,439 | 371% |
| Golden Rule Insurance Company [2991] | $4,399 | 475% |
| Oxford Health Plans [2992] | $4,399 | 475% |
| Zzumr-Salt Lake City Ut [3169] | $4,399 | 475% |