CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Uchealth Pikes Peak Regional Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,155
Cash Discount Price: $1,540
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Uchealth Pikes Peak Regional Hospital is $1,155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,540. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.25x the Medicare baseline. Located in 16420 W Us Highway 24, Woodland Park, CO.

Cash / Self-Pay

$1,540

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,155

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: $1,540 (166%)

Insurance Median: $1,155 (125%)

Cash: $1,540 (166% of Medicare)

Ins. Median: $1,155 (125% 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	$481 - $1,578	52%
Blue Cross Blue Shield	$481 - $1,287	52%
Cigna	$481 - $1,540	52%
Cms	$481	52%
Devoted Health	$481	52%
Humana	$481	52%
Kaiser	$481 - $1,636	52%
Select Health	$481 - $4,007	52%
UnitedHealthcare	$481 - $3,090	52%
Simplified Benefits Administration	$882 - $972	95%
Kaiser Public Option	$1,155	125%
Kaiser Kp Select	$1,386	150%
Multiplan/Phcs	$1,521	164%
First Health	$1,636	177%
Rocky Mountain Health Plan	$1,636	177%

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 $1,540.
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 Uchealth Pikes Peak Regional 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.