CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: South Peninsula Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,078
Cash Discount Price: $1,731
vs. Medicare Baseline: 2.24x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at South Peninsula Hospital is $2,078. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,731. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.24x the Medicare baseline. Located in 4300 Bartlett St, Homer, AK.

Cash / Self-Pay

$1,731

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,078

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: $1,731 (187%)

Insurance Median: $2,078 (224%)

Cash: $1,731 (187% of Medicare)

Ins. Median: $2,078 (224% 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 224% of the Medicare baseline (a markup of 124%). 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
Liberty Healthshare - All Plans	$241	26%
UnitedHealthcare	$402	43%
Premera First - All Plans	$598	65%
Blue Cross Blue Shield	$710	77%
Aetna	$1,962	212%
Geha - All Plans	$2,078	224%
Meritain - All Plans	$2,078	224%
Teamsters Emply - All Plans	$2,078	224%
Ufcw - All Plans	$2,078	224%
Cigna	$2,193	237%
Great West - All Plans	$2,193	237%
Moda - All Plans	$2,193	237%
Multiplan Phcs - All Plans	$2,193	237%
Pmcs - All Plans	$2,193	237%
First Choice Health - All Plans	$2,262	244%

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 $1,731.
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 South Peninsula 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.