CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Longs Peak Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,362
Cash Discount Price: $1,157
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Longs Peak Hospital is $1,362. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,157. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.47x the Medicare baseline. Located in 1750 E Ken Pratt Blvd, Longmont, CO.

Cash / Self-Pay

$1,157

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,362

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: $1,157 (125%)

Insurance Median: $1,362 (147%)

Cash: $1,157 (125% of Medicare)

Ins. Median: $1,362 (147% 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
Blue Cross Blue Shield	$598 - $1,950	65%
Select Health	$845 - $942	91%
Aetna	$942 - $3,483	102%
Cigna	$942 - $2,346	102%
Cms	$942	102%
Devoted Health	$942	102%
Humana	$942	102%
Kaiser	$942	102%
UnitedHealthcare	$942 - $4,608	102%
Simplified Benefits Administration	$1,164 - $1,382	126%
Denver Health Medical Plan	$1,654 - $1,984	178%
Rocky Mountain Health Plan	$1,687	182%
First Health	$1,951	211%
Multiplan	$1,984 - $2,282	214%
Phcs	$2,315	250%

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 $1,157.
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 Longs Peak 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.