CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: St Luke's Wood River Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,273
Cash Discount Price: $2,526
vs. Medicare Baseline: 2.45x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at St Luke's Wood River Medical Center is $2,273. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,526. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.45x the Medicare baseline. Located in 100 Hospital Drive, Ketchum, ID.

Cash / Self-Pay

$2,526

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,273

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: $2,526 (273%)

Insurance Median: $2,273 (245%)

Cash: $2,526 (273% of Medicare)

Ins. Median: $2,273 (245% 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 245% of the Medicare baseline (a markup of 145%). 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
Commercial [1028]	$1,440 - $2,450	155%
Medicare (plans)	$1,440 - $1,469	155%
Veterans Affairs [1056]	$1,440	155%
Blue Cross Blue Shield	$1,454 - $2,160	157%
UnitedHealthcare	$1,512 - $2,286	163%
Aetna	$1,584 - $2,400	171%
Moda [1055]	$2,223	240%
Geha [1065]	$2,286	247%
United Medical Resources [1051]	$2,286	247%
Cigna	$2,349	253%
Providence [1022]	$2,349	253%
Pacificsource [1020]	$2,374	256%
First Health [1064]	$2,400 - $2,450	259%
Webtpa [1071]	$2,400	259%

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 $2,526.
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 St Luke's Wood River Medical Center 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.