CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Poudre Valley Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,084
Cash Discount Price: $2,278
vs. Medicare Baseline: 2.25x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Poudre Valley Hospital is $2,084. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,278. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.25x the Medicare baseline. Located in 1024 S Lemay Ave, Fort Collins, CO.

Cash / Self-Pay

$2,278

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,084

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: $2,278 (246%)

Insurance Median: $2,084 (225%)

Cash: $2,278 (246% of Medicare)

Ins. Median: $2,084 (225% 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 225% of the Medicare baseline (a markup of 125%). 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
Blue Cross Blue Shield	$615 - $9,163	66%
Select Health	$834 - $1,386	90%
Aetna	$942 - $2,691	102%
Cigna	$942 - $8,098	102%
Cms	$942	102%
Devoted Health	$942	102%
Humana	$942	102%
Kaiser	$942	102%
UnitedHealthcare	$942 - $2,691	102%
Simplified Benefits Administration	$1,230 - $2,646	133%
First Health	$1,920	207%
Denver Health Medical Plan	$2,538	274%
Midlands Choice	$2,929	316%
Rocky Mountain Health Plans	$2,929	316%
Multiplan	$2,961	320%
Phcs	$2,961	320%
First Choice Of The Midwest	$3,156	341%

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 $2,278.
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 Poudre Valley 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.