CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Stone County Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $99
Cash Discount Price: $258
vs. Medicare Baseline: 0.11x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Stone County Medical Center is $99. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $258. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.11x the Medicare baseline. Located in 2106 East Main Street, Mountain View, AR.

Cash / Self-Pay

$258

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: $258 (28%)

Insurance Median: $99 (11%)

Cash: $258 (28% 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
Aetna	$93 - $303	10%
Arkansas Superior Select Scmc	$93	10%
Blue Cross Blue Shield	$93 - $840	10%
Hmo Partners Inc Scmc	$93	10%
Medicare (plans)	$93 - $95	10%
Medipak Advantage Scmc	$93	10%
UnitedHealthcare	$93	10%
Cigna	$96	10%
Allwell Scmc	$98	11%
Wellcare Scmc	$98	11%
Arkansas Caresource	$100	11%
Municipal Health Benefit Fund	$100	11%
Ambetter / Centene	$125	13%
Qualchoice (Alliance) Scmc	$135	15%
Provider Network Of America Scmc	$149	16%
Multiplan	$241	26%

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 $258.
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 Stone County 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.