CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Charleston Area Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $927
Cash Discount Price: $1,610
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Charleston Area Medical Center is $927. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,610. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.00x the Medicare baseline. Located in 501 Morris Street, Charleston, WV.

Cash / Self-Pay

$1,610

Average discount available for prompt cash payment at this facility.

Insurance Median

$927

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: $1,610 (174%)

Insurance Median: $927 (100%)

Cash: $1,610 (174% of Medicare)

Ins. Median: $927 (100% 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
Aetna	$103 - $1,578	11%
The Health Plan Of West Virginia Inc.	$103 - $1,562	11%
Unicare Health Plan Of West Virginia Inc.	$103 - $240	11%
Choicecare Network	$157 - $1,578	17%
Blue Cross Blue Shield	$173 - $1,468	19%
Triwest Va	$368 - $899	40%
Optimum Choice Inc.	$379 - $927	41%
UnitedHealthcare	$379 - $1,578	41%
West Virginia Senior Advantage Inc.	$398 - $973	43%
City Of Charleston	$493 - $1,208	53%
Naphcare	$520 - $1,610	56%
Integrated Medical Solutions	$550 - $1,449	59%
Caresource	$569 - $1,610	61%
Tricare	$715 - $966	77%
Three Rivers Providers Network	$1,155 - $1,562	125%
Healthsmart	$1,167 - $1,578	126%
Multiplan	$1,167 - $1,578	126%
Cigna	$1,179 - $1,497	127%

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 $1,610.
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 Charleston Area 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.