CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Claiborne Memorial Medical Center
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $1,200
- Cash Discount Price: $1,200
- vs. Medicare Baseline: 1.30x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Claiborne Memorial Medical Center is $1,200. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,200. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.30x the Medicare baseline. Located in 620 East College Street, Homer, LA.
Cash / Self-Pay
$1,200
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,200
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: $1,200 (130%)
Insurance Median: $1,200 (130%)
Cash: $1,200 (130% of Medicare)
Ins. Median: $1,200 (130% 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 |
|---|---|---|
| Ambetter / Centene | $297 | 32% |
| Medicaid / KanCare | $297 - $516 | 32% |
| Aetna | $468 - $780 | 51% |
| Amerihealth Caritas La | $468 - $516 | 51% |
| Community Health Solution | $468 - $516 | 51% |
| Correctcare Intergrated | $468 - $516 | 51% |
| Healthy Blue | $468 - $516 | 51% |
| Humana | $468 - $1,221 | 51% |
| Louisiana Hc Connections | $468 - $516 | 51% |
| Magellan Services | $468 - $516 | 51% |
| UnitedHealthcare | $468 - $1,277 | 51% |
| Commercial Insurance | $480 - $1,200 | 52% |
| Meritain Health | $480 - $780 | 52% |
| Sedgwick Claims Mgmt Serv | $486 - $1,080 | 52% |
| Workman'S Comp | $486 - $1,080 | 52% |
| Coventry Healthcare | $720 | 78% |
| Geha | $840 | 91% |
| Health Plus Of La | $840 - $900 | 91% |
| Apwu Healthplan | $900 | 97% |
| Cigna | $900 | 97% |
| Great West Healthcare | $900 | 97% |
| Phcs | $960 | 104% |
| Ppo Plus | $960 | 104% |
| Aarp | $1,200 | 130% |
| Accordia National | $1,200 | 130% |
| Aflac | $1,200 | 130% |
| Alameda Alliance Forhealt | $1,200 | 130% |
| American Pioneer | $1,200 | 130% |
| Benefit Management | $1,200 | 130% |
| Benesys Inc | $1,200 | 130% |
| Business Guarantor | $1,200 | 130% |
| Chubb | $1,200 | 130% |
| Commercial Sr. Care | $1,200 | 130% |
| Employee Benefit Services | $1,200 | 130% |
| Family Life Insurance Co | $1,200 | 130% |
| Farm Bureau Insurance | $1,200 | 130% |
| Fiserv Health Benefit | $1,200 | 130% |
| Gmp | $1,200 | 130% |
| Group And Pension Admin | $1,200 | 130% |
| Group Resources | $1,200 | 130% |
| Haik Minvielle And Grubbs | $1,200 | 130% |
| Harrington Benefit Svs | $1,200 | 130% |
| Health Design Plus | $1,200 | 130% |
| Health Plan | $1,200 | 130% |
| Healthscope Benefits | $1,200 | 130% |
| Insurance Management Admi | $1,200 | 130% |
| Jefferson National | $1,200 | 130% |
| John Alden Health Ins | $1,200 | 130% |
| John Hancock | $1,200 | 130% |
| Liberty Mutual | $1,200 | 130% |
| Mailhandlers Benefit Plan | $1,200 | 130% |
| Manhattan Life Ins Co | $1,200 | 130% |
| Mega Life And Health | $1,200 | 130% |
| Msa Careguard | $1,200 | 130% |
| Mutual Of Omaha | $1,200 | 130% |
| Nalc Health Benefit Plan | $1,200 | 130% |
| Naphcare Inc. | $1,200 | 130% |
| New Era Life Ins Co | $1,200 | 130% |
| Physicians Mutual | $1,200 | 130% |
| Principal Financial Group | $1,200 | 130% |
| Prudential Healthcare | $1,200 | 130% |
| Self Pay | $1,200 | 130% |
| State Farm | $1,200 | 130% |
| State Farm Insurance | $1,200 | 130% |
| State Mutual Insurance Co | $1,200 | 130% |
| Sterling Investors Life | $1,200 | 130% |
| Tower Life | $1,200 | 130% |
| Transamerica Premier Ins | $1,200 | 130% |
| United American | $1,200 | 130% |
| United Comm Travelers | $1,200 | 130% |
| United Teachers | $1,200 | 130% |
| Usable Administrator | $1,200 | 130% |
| Visn 16 Cfu | $1,200 | 130% |
| Wausau Benefits | $1,200 | 130% |
| Webtpa | $1,200 | 130% |
| Wells Fargo | $1,200 | 130% |
| Woodmen Of The World | $1,200 | 130% |
| All Savers | $1,277 | 138% |
| Golden Rule Ins Co | $1,277 | 138% |
| United Behavioral Health | $1,277 | 138% |
| Blue Cross Blue Shield | $2,325 | 251% |