CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Camc Greenbrier Valley Medical Center, Inc

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $99
Cash Discount Price: $435
vs. Medicare Baseline: 0.11x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Camc Greenbrier Valley Medical Center, Inc is $99. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $435. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.11x the Medicare baseline. Located in 1320 Maplewood Avenue, Ronceverte, WV.

Cash / Self-Pay

$435

Average discount available for prompt cash payment at this facility.

Insurance Median

$99

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: $435 (47%)

Insurance Median: $99 (11%)

Cash: $435 (47% of Medicare)

Ins. Median: $99 (11% 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
Sentra Health	$87 - $99	9%
Aetna	$93 - $426	10%
Blue Cross Blue Shield	$93 - $173	10%
Caresource	$93 - $348	10%
The Health Plan	$93 - $392	10%
Unicare	$93	10%
Humana	$99 - $392	11%
Multiplan	$99	11%
UnitedHealthcare	$99 - $348	11%
Clear Spring Health	$102	11%
Ally Align	$104	11%
Integrated Medical Solutions	$138	15%
Naphcare	$197	21%
Greenbrier Resort	$304	33%
Healthsmart	$348	38%
Fedmed	$392	42%

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 $435.
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 Camc Greenbrier Valley Medical Center, Inc 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.