CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Goshen Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $904
Cash Discount Price: $17,816
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Goshen Hospital is $904. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $17,816. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.98x the Medicare baseline. Located in 200 High Park Ave, Goshen, IN.

Cash / Self-Pay

$17,816

Average discount available for prompt cash payment at this facility.

Insurance Median

$904

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: $17,816 (1923%)

Insurance Median: $904 (98%)

Cash: $17,816 (1923% of Medicare)

Ins. Median: $904 (98% 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
Advantage Health Solutions	$904	98%
Aetna	$904	98%
Atrio Health Plans	$904	98%
Bc Federal Employee	$904	98%
Bc Mcr Advantage Ppo	$904	98%
Blue Cross Blue Shield	$904	98%
Buckeye Health Plan	$904	98%
Cigna	$904	98%
Coventry Health And Life	$904	98%
Emblem Health	$904	98%
Freedom Healthcare	$904	98%
Geisinger Health Plan	$904	98%
Health First	$904	98%
Healthspring	$904	98%
Humana	$904	98%
Iehp Empire Health Plan	$904	98%
Independent Care Health Plan	$904	98%
Kaiser Permanente	$904	98%
Mcr Advantra Freedom	$904	98%
Mcr Allwell Mhs	$904	98%
Mcr Banner Health	$904	98%
Mcr Complete	$904	98%
Mcr Complete Ppo	$904	98%
Mcr Complete Wellmed	$904	98%
Mcr Health Alliance	$904	98%
Mcr Health Partners Plans	$904	98%
Mcr Medical Mutual Of Ohio	$904	98%
Mcr Passport Advantage	$904	98%
Mcr Secure Horizons Ppo	$904	98%
Mcr Texan Plus	$904	98%
Mcr Upmc For Life	$904	98%
Medicare (plans)	$904 - $958	98%
Meridian Complete	$904	98%
Optimum Healthcare	$904	98%
Paramount Elite	$904	98%
Primetime Health Plan	$904	98%
Simply Complete Hmo	$904	98%
The Umwa H&R Funds	$904	98%
Todays Options Pyramid Life	$904	98%
Trillium Advantage	$904	98%
Ucare For Seniors	$904	98%
Ucare Minnesota	$904	98%
UnitedHealthcare	$904	98%
Wellcare	$904	98%
Champva	$930	100%
Tricare	$930	100%
Mcr Devoted Health Plan	$958	103%
Mcr Provider Partners Hlth Pln	$1,024	111%
Ambetter / Centene	$1,303	141%
Mkt Caresource	$1,303	141%

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 $17,816.
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 Goshen 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.