CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Lost Rivers Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,802
Cash Discount Price: $1,572
vs. Medicare Baseline: 1.94x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Lost Rivers Medical Center is $1,802. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,572. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.94x the Medicare baseline. Located in 551 Highland Drive, Arco, ID.

Cash / Self-Pay

$1,572

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,802

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: $1,572 (170%)

Insurance Median: $1,802 (194%)

Cash: $1,572 (170% of Medicare)

Ins. Median: $1,802 (194% 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
Select Health Brightpath-All Other Plans	$398 - $1,802	43%
Ihcn Brightpath-All Other Plans	$420 - $1,903	45%
Tricare	$425 - $1,802	46%
Va Pccc-All Plans	$429 - $3,020	46%
Blue Cross Blue Shield	$442 - $3,179	48%
Humana	$442 - $3,179	48%
Ihcn Brightpath Mcr Adv	$442 - $2,003	48%
Molina Mcr Adv-All Plans	$442 - $2,003	48%
Pacificsource Mcr Adv	$442 - $2,003	48%
Regence/Brightpth Slhp Mcr	$442 - $2,003	48%
Select Health Mcr Adv	$442 - $2,003	48%
Prime Hlth Mcr Adv	$464 - $2,103	50%
First Choice-All Plans	$698 - $2,956	75%
Aetna	$705 - $2,988	76%
Pacificsource Navigator-All Other Plans	$712 - $3,020	77%
Altius Health Plan-All Plans	$728 - $3,084	79%
Regence Blue Shield-All Other Plans	$735 - $3,115	79%
Provider Network Of America-All Plans	$1,668	180%
Cigna	$2,956	319%
UnitedHealthcare	$3,020	326%

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 $1,572.
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 Lost Rivers 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.