Upper endoscopy with biopsy
Facility: Physicians Care Surgical Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $2,311
- Cash Discount Price: $5,439
- vs. Medicare Baseline: 2.49x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 249% of the Medicare baseline (a markup of 149%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $537 - $12,772 | 58% |
| Tricare | $537 - $12,772 | 58% |
| Vibra Health Plan | $826 - $12,772 | 89% |
| Pcsh Aarp | $826 - $12,772 | 89% |
| Cigna | $826 - $18,977 | 89% |
| Medicare (plans) | $826 - $12,772 | 89% |
| Blue Cross Blue Shield | $826 - $23,941 | 89% |
| UnitedHealthcare | $826 - $27,099 | 89% |
| Unified Health Services | $826 - $12,772 | 89% |
| Shenandoah Life | $826 - $12,772 | 89% |
| Devon Health Services | $826 - $12,772 | 89% |
| Ibc Security 65 | $826 - $12,363 | 89% |
| Gpm Health and Life Insurance Mc Supplement | $826 - $12,772 | 89% |
| Aarp | $826 - $12,772 | 89% |
| Personal Choice 65 | $826 - $12,363 | 89% |
| Keystone 65 HMO | $826 - $12,772 | 89% |
| Aetna | $826 - $23,230 | 89% |
| Connecticare | $838 - $19,575 | 90% |
| Keystone HMO | $892 - $18,753 | 96% |
| Independence Administrators | $892 - $18,753 | 96% |
| Personal Choice | $892 - $18,753 | 96% |
| Ibc - Local | $892 - $18,753 | 96% |
| Ibc 2021 | $892 - $18,753 | 96% |
| Horizon of New Jersey | $892 - $18,753 | 96% |
| Carefirst Administrators | $892 - $18,753 | 96% |
| Regence Blue Shield | $892 - $18,753 | 96% |
| Independence Federal | $892 - $18,753 | 96% |
| Ibc Local | $892 - $18,753 | 96% |
| Independence Bc | $892 - $18,753 | 96% |
| Amerihealth New Jersey HMO | $892 - $18,753 | 96% |
| Ibc | $892 - $18,753 | 96% |
| Keystone Healthplan East | $892 - $18,753 | 96% |
| Keystone Direct POS | $892 - $18,753 | 96% |
| Pcsh Ibc | $892 - $18,753 | 96% |
| Empire Plan | $892 - $18,753 | 96% |
| Amerihealth Administrators | $892 - $18,753 | 96% |
| Keystone First Healthplan | $900 - $2,850 | 97% |
| PA Health and Wellness | $900 - $2,850 | 97% |
| Keystone First | $900 - $2,850 | 97% |
| Keystone First Vip Choice | $900 - $2,850 | 97% |
| Straight Access | $900 - $2,850 | 97% |
| Medicaid / KanCare | $900 - $2,850 | 97% |
| Highmark | $1,599 - $23,941 | 173% |
| Oxford Life Insurance Company | $1,751 - $27,099 | 189% |
| Surest | $1,751 - $27,099 | 189% |
| Golden Rule Op | $1,751 - $27,099 | 189% |
| Oxford Health Plan | $1,751 - $27,099 | 189% |
| Allsavers | $1,751 - $27,099 | 189% |
| UPMC | $2,069 - $19,295 | 223% |
| Nalc Health | $2,217 - $18,977 | 239% |
| Health Partners | $2,217 - $18,977 | 239% |
| Sana Benefits | $2,217 - $18,977 | 239% |
| Freedom Life Insurance Company | $2,217 - $18,977 | 239% |
| Apwu | $2,217 - $18,977 | 239% |
| Healthgram | $2,217 - $18,977 | 239% |
| Loomis | $2,217 - $18,977 | 239% |
| Cwi Benefits | $2,217 - $18,977 | 239% |
| Central PA Teamsters | $2,243 - $21,231 | 242% |
| Allied Benefits Systems | $2,311 - $23,230 | 249% |
| Marpai Health | $2,311 - $23,230 | 249% |
| Ag Administrators Inc | $2,311 - $23,230 | 249% |
| Trustmark | $2,311 - $23,230 | 249% |
| Healthez | $2,311 - $23,230 | 249% |
| Allied Benefit Systems | $2,311 - $23,230 | 249% |
| Geha | $2,311 - $23,230 | 249% |
| Coventry | $2,311 - $23,230 | 249% |
| Premier Care Network | $2,311 - $23,230 | 249% |
| Meritain Health | $2,311 - $23,230 | 249% |
| Ag Administrators | $2,311 - $23,230 | 249% |
| Lucent Health | $2,311 - $23,230 | 249% |
| Continental Benefits | $2,311 - $23,230 | 249% |