CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Calais Community Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $948
Cash Discount Price: $2,322
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Calais Community Hospital is $948. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,322. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.02x the Medicare baseline. Located in 24 Hospital Lane, Calais, ME.

Cash / Self-Pay

$2,322

Average discount available for prompt cash payment at this facility.

Insurance Median

$948

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: $2,322 (251%)

Insurance Median: $948 (102%)

Cash: $2,322 (251% of Medicare)

Ins. Median: $948 (102% 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
Blue Cross Blue Shield	$180 - $4,225	19%
UnitedHealthcare	$180 - $4,576	19%
Humana	$383 - $2,341	41%
Wellcare	$383 - $2,341	41%
Partners Direct Health	$505 - $3,086	54%
Cigna	$732 - $4,475	79%
Aetna	$748 - $4,576	81%
Martins Point	$783 - $4,789	84%
Harvard Pilgrim	$796 - $4,869	86%

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 $2,322.
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 Calais Community 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.