CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Uva Health Haymarket Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,812
Cash Discount Price: $2,782
vs. Medicare Baseline: 1.96x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Uva Health Haymarket Medical Center is $1,812. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,782. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.96x the Medicare baseline. Located in 15225 Healthcote Boulevard, Haymarket, VA.

Cash / Self-Pay

$2,782

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,812

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: $2,782 (300%)

Insurance Median: $1,812 (196%)

Cash: $2,782 (300% of Medicare)

Ins. Median: $1,812 (196% 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
Champva [50002]	$135 - $138	15%
Tricare	$135 - $138	15%
Blue Ridge Pace [10510]	$819	88%
Medicaid / KanCare	$819	88%
Aetna	$910 - $1,814	98%
Blue Cross Blue Shield	$910 - $2,902	98%
Cigna	$910 - $6,128	98%
HMO Part B [10099]	$910	98%
Humana	$910 - $957	98%
Medicare (plans)	$910 - $938	98%
UnitedHealthcare	$910 - $5,807	98%
VA Ccn [99926]	$910 - $938	98%
VA Ccn [99927]	$910 - $938	98%
Veterans Administration [99910]	$938	101%
Beacon Health Options [40012]	$1,294	140%
Commercial Contracted Hb Only [40056]	$1,359	147%
Commercial Generic [40000]	$1,359 - $1,812	147%
Commercial Contracted Tpa [40055]	$1,553 - $1,812	168%
Umwa [40037]	$1,812	196%
Geha [40009]	$1,911 - $4,651	206%
Healthsmart [40013]	$1,941	209%
First Health Generic [40033]	$2,122	229%
Gateway Health Alliance [40034]	$2,200	237%
Multiplan Generic [40035]	$2,200 - $2,528	237%
Vhn Generic [40040]	$2,200 - $2,528	237%
Onenet Workers Comp Generic [60010]	$2,267	245%
Kaiser Permenente [40014]	$2,993	323%
Carefirst [30007]	$3,044 - $3,448	329%

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 $2,782.
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 Uva Health Haymarket Medical Center 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.