CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Saint Joseph Regional Medical Center - Plymouth
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $58
- Cash Discount Price: $389
- vs. Medicare Baseline: 0.06x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Saint Joseph Regional Medical Center - Plymouth is $58. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $389. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.06x the Medicare baseline. Located in 1915 Lake Ave, Plymouth, IN.
Cash / Self-Pay
$389
Average discount available for prompt cash payment at this facility.
Insurance Median
$58
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: $389 (42%)
Insurance Median: $58 (6%)
Cash: $389 (42% of Medicare)
Ins. Median: $58 (6% 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
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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 | $44 - $497 | 5% |
| Aetna | $57 - $1,487 | 6% |
| Align Senior Care | $57 | 6% |
| Ally Align Care Adv | $57 | 6% |
| American Health Advantage Of Idaho | $57 | 6% |
| American Health Plan | $57 | 6% |
| Aurora Special Needs | $57 | 6% |
| Blue Care Network Advantage | $57 | 6% |
| Blue Cross Blue Shield | $57 - $3,388 | 6% |
| Blue Shield - De (Highmark) Medciare Advantage | $57 | 6% |
| Care Dimensions | $57 | 6% |
| Care Improvement Plus | $57 | 6% |
| Care Resources Pace | $57 | 6% |
| Careplus Health Plans | $57 | 6% |
| Cca - Zing Health | $57 | 6% |
| Cca Senior Care Options | $57 | 6% |
| Central Valley Medical Services Corp Pace | $57 | 6% |
| Champion Health Plan Mcr Advantage | $57 | 6% |
| Cigna | $57 - $147 | 6% |
| Clear Spring Health | $57 | 6% |
| Clover Health | $57 | 6% |
| Commonwealth Care Alliance | $57 | 6% |
| Community Pace At Home | $57 | 6% |
| Eddy Senior Care-Pace | $57 | 6% |
| Eddy Seniorcare Pace | $57 | 6% |
| Elementcare | $57 | 6% |
| Evercare | $57 | 6% |
| Everence | $57 | 6% |
| Gateway Health Plan | $57 | 6% |
| Genesys Pace Of Genesee County | $57 | 6% |
| Georgia Health Advantage | $57 | 6% |
| Gold Advantage | $57 | 6% |
| Gpa Croell Redi Mix | $57 | 6% |
| Health America Advantra | $57 | 6% |
| Highmark Health Options Dual Plan | $57 | 6% |
| Hope Select Pace | $57 | 6% |
| Horizon Nj Total Care | $57 | 6% |
| Hudson Headwaters Pace | $57 | 6% |
| Humana | $57 - $62 | 6% |
| Huron Valley Pace | $57 | 6% |
| Innovative Integrated Health Community Plans | $57 | 6% |
| Iowa Health Advantage | $57 | 6% |
| Johns Hopkins Advantage Md | $57 | 6% |
| Lasso Healthcare Msa | $57 | 6% |
| Life St Marys Pace | $57 | 6% |
| Lifecircles Pace | $57 | 6% |
| Longevity Health Plan | $57 | 6% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $57 | 6% |
| Martins Point Generations Advantage | $57 | 6% |
| Mass General Brigham Mcr Adv | $57 | 6% |
| Medicare (plans) | $57 - $979 | 6% |
| Medipak Advantage | $57 | 6% |
| Mercy Life | $57 | 6% |
| Mercyone Cedar Valley | $57 | 6% |
| Meridian Complete | $57 - $960 | 6% |
| Michigan Complete Health | $57 | 6% |
| Nascentia Health Plus | $57 | 6% |
| New Centry Health Careplus | $57 | 6% |
| Osu Prime Care Advantage | $57 | 6% |
| Pace Cny | $57 | 6% |
| Pace Iowa Immanuel Pathways | $57 | 6% |
| Pace Of Southwest Michigan | $57 - $62 | 6% |
| Pace Southeast | $57 | 6% |
| Pace-Trinity Health | $57 - $960 | 6% |
| Peak Pace Solutions | $57 | 6% |
| Perennial Advantage | $57 | 6% |
| Preferred Care Partners | $57 | 6% |
| Presbyterian Senior Plan | $57 | 6% |
| Provider Partners Health Plan Of Illinois | $57 | 6% |
| Pruitthealth Premier | $57 | 6% |
| Reliance Community Care Partners Care Resources Pace | $57 | 6% |
| Rx Allwin | $57 | 6% |
| Rx Grane Grnmedd | $57 | 6% |
| Rx Retiree Rx Care | $57 | 6% |
| Scan Health Plan Mcr Ipa Meritage Oon | $57 | 6% |
| Secure Horizons Ma Pffs | $57 | 6% |
| Serenity Pace | $57 | 6% |
| Siouxland Pace | $57 | 6% |
| Solis Health Plans | $57 | 6% |
| Sunnyview-Pace Finance Dept | $57 | 6% |
| Texan Plus | $57 | 6% |
| The Health Plan | $57 | 6% |
| Thome Pace | $57 | 6% |
| Todays Options | $57 | 6% |
| Tribute Health Plans | $57 | 6% |
| Um Health Advantage | $57 | 6% |
| Union Health Service | $57 | 6% |
| UnitedHealthcare | $57 - $959 | 6% |
| Welbe Health | $57 | 6% |
| Wellmed | $57 | 6% |
| Andrie Inc | $58 | 6% |
| East Greenbush Central School District | $58 | 6% |
| Genex Wc | $58 | 6% |
| Healthsmart Workers Comp | $58 | 6% |
| Jag Source | $58 | 6% |
| New York State Insurance Fund | $58 | 6% |
| Njm Insurance Group | $58 | 6% |
| Rx Heatlhcomp | $58 | 6% |
| Rx Restat | $58 | 6% |
| Rx Saif Opdp Wc | $58 | 6% |
| Rx Worker'S Comp | $58 | 6% |
| Veterans Administration | $58 | 6% |
| Wc Accident Fund | $58 | 6% |
| Wc Ace | $58 | 6% |
| Wc Acs Federal Employees | $58 | 6% |
| Wc Acuity | $58 | 6% |
| Wc Advantage | $58 | 6% |
| Wc Aegis | $58 | 6% |
| Wc Aig | $58 | 6% |
| Wc Aims | $58 | 6% |
| Wc Alaska National Ins | $58 | 6% |
| Wc Align Network | $58 | 6% |
| Wc Allied | $58 | 6% |
| Wc Am Trust N America | $58 | 6% |
| Wc American Claims Mgmt | $58 | 6% |
| Wc Amerisure | $58 | 6% |
| Wc Amtrust | $58 | 6% |
| Wc Asu Risk Mgt | $58 | 6% |
| Wc Benetech | $58 | 6% |
| Wc Berkley Admin | $58 | 6% |
| Wc Broadspire | $58 | 6% |
| Wc Broward County | $58 | 6% |
| Wc Bunch & Associates | $58 | 6% |
| Wc California State Comp Ins | $58 | 6% |
| Wc California State Ins Fund | $58 | 6% |
| Wc Capitol Area Health Consortium | $58 | 6% |
| Wc Ccmsi | $58 | 6% |
| Wc Chartis | $58 | 6% |
| Wc Chubb | $58 | 6% |
| Wc Cirma | $58 | 6% |
| Wc City Of Albany | $58 | 6% |
| Wc City Of Sioux City | $58 | 6% |
| Wc Claims Mgmt Inc | $58 | 6% |
| Wc Cna | $58 | 6% |
| Wc Comp One Admin C/O Manageability | $58 | 6% |
| Wc Compone Admin | $58 | 6% |
| Wc Corvel | $58 | 6% |
| Wc Ct Healthcare Trust | $58 | 6% |
| Wc Donegal Insurance Group | $58 | 6% |
| Wc Emc Insurance Company | $58 | 6% |
| Wc Employee Mutual | $58 | 6% |
| Wc Enablecomp | $58 | 6% |
| Wc Erie | $58 | 6% |
| Wc Esis | $58 | 6% |
| Wc Evolutions | $58 | 6% |
| Wc Fcci | $58 | 6% |
| Wc Fed Ex | $58 | 6% |
| Wc Federal Black Lung | $58 | 6% |
| Wc Federated | $58 | 6% |
| Wc Finley Occupational Health | $58 | 6% |
| Wc First Agency/Occunet | $58 | 6% |
| Wc Ford Motor | $58 | 6% |
| Wc Fresno Unified Emp | $58 | 6% |
| Wc Gallagher Bassett | $58 | 6% |
| Wc General Motors | $58 | 6% |
| Wc Generic | $58 | 6% |
| Wc Genex Care For Ohio | $58 | 6% |
| Wc Great West Casualty | $58 | 6% |
| Wc Guarantee Insurance | $58 | 6% |
| Wc Guard Insurance Company | $58 | 6% |
| Wc Hab | $58 | 6% |
| Wc Hartford | $58 | 6% |
| Wc Hastings | $58 | 6% |
| Wc Health Management | $58 | 6% |
| Wc Heritage Summit | $58 | 6% |
| Wc Hireright | $58 | 6% |
| Wc Horizon | $58 | 6% |
| Wc Icw Group | $58 | 6% |
| Wc Idaho State Ins Fund | $58 | 6% |
| Wc Intercare Insurance | $58 | 6% |
| Wc Intermountain | $58 | 6% |
| Wc Johns Eastern | $58 | 6% |
| Wc Kemberton | $58 | 6% |
| Wc Key Ins & Benefit Solutions | $58 | 6% |
| Wc Liberty Mutual | $58 | 6% |
| Wc Mac Risk Management | $58 | 6% |
| Wc Massachusetts | $58 | 6% |
| Wc Mdia | $58 | 6% |
| Wc Meadowbrook Claim | $58 | 6% |
| Wc Medical Administrators | $58 | 6% |
| Wc Meijers | $58 | 6% |
| Wc Memic | $58 | 6% |
| Wc Mercy Workcare | $58 | 6% |
| Wc Michigan | $58 | 6% |
| Wc Michigan Millers Mutual | $58 | 6% |
| Wc Mitchell Frankenmuth | $58 | 6% |
| Wc Mra | $58 | 6% |
| Wc Nationwide | $58 | 6% |
| Wc Nca Comp | $58 | 6% |
| Wc New York | $58 | 6% |
| Wc New York Special Funds | $58 | 6% |
| Wc North American Rishces | $58 | 6% |
| Wc Northeast Health | $58 | 6% |
| Wc Notre Dame | $58 | 6% |
| Wc Novanet | $58 | 6% |
| Wc O'Hara Corp | $58 | 6% |
| Wc Occ Health Allen | $58 | 6% |
| Wc Ohio Bureau | $58 | 6% |
| Wc One Call Medical | $58 | 6% |
| Wc Paradigm | $58 | 6% |
| Wc Peerless | $58 | 6% |
| Wc Pma | $58 | 6% |
| Wc Praxis Health Network | $58 | 6% |
| Wc Price Chopper | $58 | 6% |
| Wc Procura Management | $58 | 6% |
| Wc Qualcare | $58 | 6% |
| Wc Quiktrip | $58 | 6% |
| Wc Reny Company | $58 | 6% |
| Wc Rev Claims | $58 | 6% |
| Wc Risico | $58 | 6% |
| Wc Rural Mutual | $58 | 6% |
| Wc Saif Oregon | $58 | 6% |
| Wc Secura | $58 | 6% |
| Wc Sedgwick | $58 | 6% |
| Wc Sentry | $58 | 6% |
| Wc Sheakley Unicomp | $58 | 6% |
| Wc Smile Lodge | $58 | 6% |
| Wc Society | $58 | 6% |
| Wc Srs | $58 | 6% |
| Wc Taconic (Mro) | $58 | 6% |
| Wc Taconic Farms | $58 | 6% |
| Wc Travelers | $58 | 6% |
| Wc Triad Group | $58 | 6% |
| Wc Tristar | $58 | 6% |
| Wc Troy Ny | $58 | 6% |
| Wc Tyson | $58 | 6% |
| Wc Unified Health Services | $58 | 6% |
| Wc United Heartland | $58 | 6% |
| Wc Us Dept Of Labor | $58 | 6% |
| Wc Velocity | $58 | 6% |
| Wc Walmart | $58 | 6% |
| Wc West Bend | $58 | 6% |
| Wc West Bend Mutual/Argent | $58 | 6% |
| Wc Winnebago Industries | $58 | 6% |
| Wc Yankee Trails | $58 | 6% |
| Wc York Risk | $58 | 6% |
| Wc Zenith | $58 | 6% |
| Wc Zurich | $58 | 6% |
| Albany County Correctional Facility | $62 | 7% |
| Ambetter / Centene | $62 | 7% |
| Amish Mennonite | $62 | 7% |
| Ascension St. Vincent Public Safety Medical | $62 | 7% |
| Bcccp-Michigan | $62 | 7% |
| Bccp | $62 | 7% |
| Bmc Healthnet | $62 | 7% |
| Breast Grant-Connecticut | $62 | 7% |
| Broward County Dept Of Health | $62 | 7% |
| California Health And Wellness | $62 | 7% |
| Cardinal Innovations Lme | $62 | 7% |
| Care Connections Of Northern Iowa | $62 | 7% |
| Care Oregon Ohp | $62 | 7% |
| Cencal Health Plan | $62 | 7% |
| Cenpatico | $62 | 7% |
| Champva | $62 | 7% |
| Chhuny | $62 | 7% |
| Childrens Comm Health Plan | $62 | 7% |
| Childrens Medical Services Title 19 | $62 | 7% |
| City Of Philadelphia | $62 | 7% |
| Cmh Allegan County | $62 | 7% |
| Cmh Ausable Valley | $62 | 7% |
| Cmh Barry County | $62 | 7% |
| Cmh Bay-Arenac County | $62 | 7% |
| Cmh Berrien County | $62 | 7% |
| Cmh Cass County | $62 | 7% |
| Cmh Central Mi County | $62 | 7% |
| Cmh Clinton-Eaton-Ingham County | $62 | 7% |
| Cmh Detroit Wayne Integrated Health Network | $62 | 7% |
| Cmh Genesee County | $62 | 7% |
| Cmh Ionia County | $62 | 7% |
| Cmh Jackson County/Lifeways | $62 | 7% |
| Cmh Kalamazoo | $62 | 7% |
| Cmh Kent County | $62 | 7% |
| Cmh Lenawee County | $62 | 7% |
| Cmh Livingston County | $62 | 7% |
| Cmh Macomb | $62 | 7% |
| Cmh Misc | $62 | 7% |
| Cmh Monroe County | $62 | 7% |
| Cmh Montcalm County | $62 | 7% |
| Cmh Muskegon County | $62 | 7% |
| Cmh Newaygo County | $62 | 7% |
| Cmh North Country | $62 | 7% |
| Cmh Northern Lakes County | $62 | 7% |
| Cmh Oakland County | $62 | 7% |
| Cmh Ottawa County | $62 | 7% |
| Cmh Van Buren County | $62 | 7% |
| Cmh Washtenaw County | $62 | 7% |
| Cmh Wayne County/Carelink | $62 | 7% |
| Cmh Wayne Cty/Com Liv Svcs | $62 | 7% |
| Cmh West Mi County | $62 | 7% |
| Community Benefit Health | $62 | 7% |
| Community Care Behavorial Health | $62 | 7% |
| Community Care Partners | $62 | 7% |
| Community Health Choice | $62 | 7% |
| Connections Csp | $62 | 7% |
| County Coroner | $62 - $998 | 7% |
| County Funding Generic | $62 | 7% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $62 | 7% |
| Dean Wi Badgercare | $62 | 7% |
| Delaware County Department Of Health | $62 | 7% |
| Delaware First Health | $62 | 7% |
| Delta Dental Nj | $62 | 7% |
| Dph Tb Program | $62 | 7% |
| Dscc | $62 | 7% |
| Eastpointe Lme | $62 | 7% |
| Family Health Network | $62 | 7% |
| Freedom First Healthcare | $62 | 7% |
| Fresno County Ccs | $62 | 7% |
| Ghc Scw Wi Badgercare | $62 | 7% |
| Harbor Health | $62 | 7% |
| Health Safety Net | $62 | 7% |
| Healthy Blue Ne | $62 | 7% |
| Hennepin Health | $62 | 7% |
| Id County Ada | $62 | 7% |
| Id County Canyon | $62 | 7% |
| Id County Cat Fund | $62 | 7% |
| Id County Other | $62 | 7% |
| Id County Payette | $62 | 7% |
| Idaho Dept Health And Wellfare | $62 | 7% |
| Idaho Womens Health Check | $62 | 7% |
| Indiana Breast Cervical Cancer | $62 | 7% |
| Inland Empire Health Plan | $62 | 7% |
| Intercommunity Health Ohp | $62 | 7% |
| Iowa Total Care | $62 | 7% |
| Jai Medical System | $62 | 7% |
| Kern Family Health Plan | $62 | 7% |
| Keystone First | $62 | 7% |
| Keystone First Chip | $62 | 7% |
| La Care Health Plan | $62 | 7% |
| Lakeland Care Inc | $62 | 7% |
| Managed Health Services - Indiana | $62 - $153 | 7% |
| Maryland Breast & Cervical Program | $62 | 7% |
| Maryland Healthy Smiles - Scion Dental | $62 | 7% |
| Maryland Physicians Care | $62 | 7% |
| Massachusetts Behavioral Health Partnership | $62 | 7% |
| Mdwise | $62 - $153 | 7% |
| Medi-Cal | $62 | 7% |
| Medi-Cal Healthnet | $62 | 7% |
| Medstar Dc Healthy Family | $62 | 7% |
| Medstar Md Health Choice | $62 | 7% |
| Mo Home State Health Plan | $62 | 7% |
| Molina Centennial Care | $62 | 7% |
| Nascentia Health Options | $62 | 7% |
| Nebraska Total Care | $62 | 7% |
| New York Cancer Services Program | $62 | 7% |
| Nextlevel Health | $62 | 7% |
| Oregon Screenwise | $62 | 7% |
| Paramount Advantage | $62 | 7% |
| Parkland Community Health Plan | $62 | 7% |
| Partners Behavioral Lme | $62 | 7% |
| Peach State Healthplan | $62 | 7% |
| Philadelphia County Funding | $62 | 7% |
| Presbyterian Centennial Care | $62 | 7% |
| Prestige Health Choice | $62 | 7% |
| Priority Partners | $62 | 7% |
| Robert F Sing Program | $62 | 7% |
| Rx 340B Pass Along | $62 | 7% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $62 | 7% |
| Rx Medi-Cal | $62 | 7% |
| Rx Meridian Rx | $62 | 7% |
| Ryan White Florida Mssrp | $62 | 7% |
| Sandhills Center Lme | $62 | 7% |
| Screening For Life | $62 | 7% |
| St Joseph County Hlth Dpt | $62 - $1,439 | 7% |
| Stephenson Cty Health | $62 | 7% |
| Sunshine State Health Plan | $62 | 7% |
| Superior Health | $62 | 7% |
| Tenncare | $62 | 7% |
| Texas Children'S Health Plan | $62 | 7% |
| Tricare | $62 | 7% |
| Trillium Community Ohp | $62 | 7% |
| Triwest Health Alliance | $62 | 7% |
| Tufts Health Public Plans | $62 | 7% |
| Us Family Health Plan | $62 | 7% |
| Vaya Health Lme | $62 | 7% |
| Veterans Eval Services | $62 | 7% |
| Washtenaw Health Plan | $62 | 7% |
| Wellsense Health Plan | $62 | 7% |
| Wi Womens Wellness | $62 | 7% |
| Provider Partners Health Plan Of Indiana | $64 - $1,056 | 7% |
| Caresource | $76 - $1,487 | 8% |
| Ameriben | $87 | 9% |
| Christian Brother Services | $101 | 11% |
| Meritain | $101 | 11% |
| Preferred One | $101 | 11% |
| Geha | $116 | 13% |
| Allied Benefit Systems | $138 - $1,823 | 15% |
| Auxiant | $138 - $2,063 | 15% |
| Benefit Administrative Systems,Llc | $138 | 15% |
| Custom Design Benefits | $138 - $2,063 | 15% |
| Encore Health | $138 - $147 | 15% |
| Key Benefit Administrator | $138 - $2,063 | 15% |
| Luminare Health (Detroit) | $138 | 15% |
| Physicians Health Plan Northern Indiana Health Insurance | $138 - $2,898 | 15% |
| Sagamore Health Network | $147 | 16% |
| Signature Care | $147 | 16% |
| Wc Encore Health Network | $150 - $194 | 16% |
| Bcn Domestic | $158 | 17% |
| Blue Benefit Administrators Of Massachusetts | $158 - $3,388 | 17% |
| Blue Care Network | $158 - $3,388 | 17% |
| Blue Distinction Transplant | $158 - $3,388 | 17% |
| Blue Shield - Ca | $158 - $3,388 | 17% |
| Blue Shield - Id (Regence) | $158 - $3,388 | 17% |
| Blue Shield - Ny Highmark Northeastern | $158 - $3,388 | 17% |
| Blue Shield - Ny Highmark Western | $158 - $3,388 | 17% |
| Blue Shield - Pa (Highmark) | $158 - $3,388 | 17% |
| Blue Shield - Wa (Regence) | $158 - $3,388 | 17% |
| Health Choices | $158 | 17% |
| Kaiser Domestic | $158 | 17% |
| Pre-Employment | $158 | 17% |
| Wc Domestic | $158 | 17% |
| Community Health Alliance | $169 | 18% |
| Phcs | $271 - $350 | 29% |
| Plain Church Group | $301 - $389 | 32% |
| Siho Insurance Services | $1,535 | 166% |