CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Harrison County Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $130
Cash Discount Price: $464
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Harrison County Hospital is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $464. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.14x the Medicare baseline. Located in 245 Atwood Street, Corydon, IN.

Cash / Self-Pay

$464

Average discount available for prompt cash payment at this facility.

Insurance Median

$130

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: $464 (50%)

Insurance Median: $130 (14%)

Cash: $464 (50% of Medicare)

Ins. Median: $130 (14% 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
Tricare	$107	12%
Aetna	$116 - $331	13%
Blue Cross Blue Shield	$116 - $516	13%
Buckeye Exchange-All Plans	$116	13%
Caresource Mcaid Hip	$116	13%
Caresource Mcr Adv	$116	13%
Mdwise Mcaid Hip	$116	13%
Mhs Exchange-All Other Plans	$116	13%
Mhs Mcaid Hip	$116	13%
Passport Mcr Adv	$116	13%
UnitedHealthcare	$116 - $331	13%
Mhs Mcr Adv	$117	13%
Communicare Adv-All Plans	$119	13%
Caresource Exchange-All Other Plans	$122	13%
Siho Exchange	$151	16%
Siho One Southern	$151	16%
Siho Ppo/Hmo - All Other Plans	$151	16%
Encore Encircle	$157	17%
Encore Ppo - All Other Plans	$157	17%
Cigna	$160	17%
Sagamore-All Plans	$160	17%
Caresource Mcaid Hhw	$331	36%
Mdwise Mcaid Hhw/Hcc - All Other Plans	$331	36%
Mhs Mcaid Hhw/Hcc	$331	36%
Passport Mcaid-All Other Plans	$331	36%
Beech Street Comm-All Plans	$657	71%
First Health-All Plans	$657	71%
Multiplan-All Plans	$696	75%

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 $464.
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 Harrison County 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.