Upper endoscopy with biopsy
Facility: The Orthopaedic Hospital of Lutheran Health Networ
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $263
- Cash Discount Price: $103
- vs. Medicare Baseline: 0.28x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Amish Aid | $89 - $177 | 10% |
| Self Pay | $89 - $177 | 10% |
| Lutheran Preferred | $96 - $1,439 | 10% |
| Cigna | $115 - $657 | 12% |
| Aetna | $128 - $944 | 14% |
| Physicians Health Plan | $128 - $1,792 | 14% |
| Three Rivers Preferred | $132 - $296 | 14% |
| Sagamore | $158 - $355 | 17% |
| Encore Ppo | $164 - $328 | 18% |
| Multiplan | $227 - $512 | 24% |
| Prime Health Services | $247 - $1,727 | 27% |
| First Health | $253 - $506 | 27% |
| Encore | $263 - $526 | 28% |
| One Call Work Comp | $366 | 39% |
| UnitedHealthcare | $850 - $960 | 92% |
| Blue Cross Blue Shield | $944 - $3,944 | 102% |
| Humana | $944 | 102% |
| Iu Health Plan | $944 | 102% |
| Medicare (plans) | $944 | 102% |
| Node Mhs Mcr Adv | $944 | 102% |
| Small Business Aid | $944 | 102% |
| Node Hospice Non Par Agree | $960 | 104% |
| Node Va | $960 | 104% |
| Node Devoted Health Mcr Adv | $963 | 104% |
| Police And Sheriff | $978 | 106% |
| In Dept Of Correction | $998 | 108% |
| Node Pphp Mcr Adv | $1,008 | 109% |
| Node Us Dept Of Labor | $1,200 | 130% |
| Lutheran Advanced Network | $1,439 | 155% |
| Node Lutheran Three Rivers Preferred Plus 150 | $1,439 | 155% |
| Occunet In Work Comp | $1,439 | 155% |
| Align Network | $1,535 | 166% |
| Node Lutheran Three Rivers Preferred Plus 175 | $1,679 | 181% |
| Encore Wc | $1,727 | 186% |
| Medrisk In Work Comp | $1,727 | 186% |
| Three Rivers Preferred In Work Comp | $1,727 | 186% |
| Objective Surgical | $1,871 | 202% |
| In Work Comp | $1,919 | 207% |
| Lutheran Network | $1,919 | 207% |
| Managed Health Services | $1,919 | 207% |
| Encore Kba Epo | $2,303 | 249% |
| Php Freedom Network | $2,690 | 290% |
| Encore Kba Ppo | $2,879 | 311% |