CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Memorial Hospital and Health Care Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $321
Cash Discount Price: $455
vs. Medicare Baseline: 0.35x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Memorial Hospital and Health Care Center is $321. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $455. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.35x the Medicare baseline. Located in 800 W 9Th St, Jasper, IN.

Cash / Self-Pay

$455

Average discount available for prompt cash payment at this facility.

Insurance Median

$321

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: $455 (49%)

Insurance Median: $321 (35%)

Cash: $455 (49% of Medicare)

Ins. Median: $321 (35% 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	$124 - $982	13%
Blue Cross Blue Shield	$124 - $982	13%
Caresource In Marketplace	$124 - $1,228	13%
Humana	$124 - $982	13%
Tricare	$124 - $835	13%
Mdwise	$126	14%
Mhs Hoosier Care Connect	$126	14%
Immergrun	$149 - $1,179	16%
Ambetter / Centene	$161 - $1,277	17%
Noncontracted	$199 - $1,571	21%
Onecare	$205	22%
Siho	$205	22%
Chamber Care	$211	23%
UnitedHealthcare	$248 - $2,947	27%
Patoka Valley	$485	52%
Encore	$495	53%
Encore Elite +	$495 - $2,357	53%
Cigna	$609	66%
Sagamore	$609	66%

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 $455.
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 Memorial Hospital and Health Care 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.