CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Gunnison Valley Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,120
Cash Discount Price: $1,360
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Gunnison Valley Hospital is $1,120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,360. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.21x the Medicare baseline. Located in 711 N Taylor St, Gunnison, CO.

Cash / Self-Pay

$1,360

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,120

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: $1,360 (147%)

Insurance Median: $1,120 (121%)

Cash: $1,360 (147% of Medicare)

Ins. Median: $1,120 (121% 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	$115	12%
Medicare (plans)	$134	14%
Aetna	$194	21%
Apostrophe-All Plans	$221	24%
Cigna	$221	24%
Gunnison County Sheriff Op & Profee Only	$821	89%
Ebms Hdhp	$960	104%
Tetwp Op & Profee Only-All Plans	$960	104%
U Of Co Transplant-All Plans	$960	104%
Ebms Ppo Plan-All Other Plans	$1,120	121%
Gunnison County Employees-All Other Plans	$1,280	138%
Scottish Rites-All Plans	$1,280	138%
Elap Employers-All Plans	$1,360	147%
Blue Cross Blue Shield	$1,403	151%
Multiplan-All Plans	$1,440	155%
Rocky Mountain Health-All Plans	$1,520	164%
UnitedHealthcare	$1,520	164%
Cofinity-All Plans	$1,536	166%

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 $1,360.
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 Gunnison 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.