CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Boulder Community Health

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $640
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.69x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Boulder Community Health is $640. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.69x the Medicare baseline. Located in 4747 Arapahoe Avenue, Boulder, CO.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$640

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%)

Insurance Median: $640 (69%)

Ins. Median: $640 (69% 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
Medicaid / KanCare	$117	13%
Rocky Mountain Health Maintenance Organization	$117 - $970	13%
Colorado Access	$129 - $519	14%
UnitedHealthcare	$134 - $968	14%
Humana	$136 - $942	15%
Beech Street Community Medical Associates	$210	23%
Multiplan	$217	23%
Phcs	$217	23%
Cigna	$221 - $4,092	24%
Aetna	$270 - $942	29%
Blue Cross Blue Shield	$370 - $3,560	40%
Devoted Health	$370 - $942	40%
Health Spring	$370 - $942	40%
Medicare (plans)	$370 - $970	40%
Clear Spring	$382 - $970	41%
Select Health Colorado Public Option	$519 - $2,073	56%
Select Health Value Network	$519 - $2,195	56%
Kaiser Ppo	$570 - $2,218	62%
Kaiser Public Option	$570 - $1,807	62%
Kaiser	$2,208	238%

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 $X.
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 Boulder Community Health 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.