CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,864
Cash Discount Price: $1,163
vs. Medicare Baseline: 2.01x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Carilion Stonewall Jackson Hospital is $1,864. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,163. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.01x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.

Cash / Self-Pay

$1,163

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,864

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: $1,163 (126%)

Insurance Median: $1,864 (201%)

Cash: $1,163 (126% of Medicare)

Ins. Median: $1,864 (201% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 201% of the Medicare baseline (a markup of 101%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Humana	$119 - $864	13%
Blue Cross Blue Shield	$337 - $4,233	36%
Sentara Health Plan	$343 - $2,060	37%
Abh of VA (Formerly Coventry)	$353	38%
Abh of Wva (Formerly Coventry)	$353	38%
UnitedHealthcare	$353 - $2,716	38%
Aetna	$796 - $2,206	86%
Gateway - Tier 3	$1,828	197%
Vhn - Ultra	$2,060	222%
Connecticare	$2,326	251%
Gateway - Tier 2	$2,658	287%
Vhn - Plus	$2,658	287%
Cigna	$2,662	287%
Integrated Health Plan	$2,825	305%
Vhn	$2,825	305%
Vhn - Link	$2,991	323%
Beech Street	$3,057	330%
Gateway - Tier 1	$3,157	341%
Vhn - Secondary Payors	$3,157	341%

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 $1,163.
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 Carilion Stonewall Jackson 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.