CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Central Montana Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,668
Cash Discount Price: $1,471
vs. Medicare Baseline: 1.80x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Central Montana Medical Center is $1,668. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,471. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.80x the Medicare baseline. Located in 408 Wendell Ave, Lewistown, MT.

Cash / Self-Pay

$1,471

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,668

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: $1,471 (159%)

Insurance Median: $1,668 (180%)

Cash: $1,471 (159% of Medicare)

Ins. Median: $1,668 (180% 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	$132 - $3,147	14%
Humana	$132 - $1,700	14%
Triwest - All Plans	$132 - $1,668	14%
Veterans Affairs - All Plans	$132 - $1,668	14%
Montana Health Co-Op - All Plans	$217 - $3,053	23%
Allegiance Comm - All Other Plans	$226 - $3,022	24%
Allegiance Rbphp	$226 - $5,697	24%
Ebms - All Plans	$239 - $2,990	26%
Health Infonet - All Plans	$239 - $3,022	26%
Coventry/First Health - All Plans	$2,927	316%
UnitedHealthcare	$2,927	316%
Interwest Ppo	$3,084	333%
Pacific Source Hp - All Plans	$3,084	333%
Interwest Trad - All Other Plans	$3,147	340%

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 $1,471.
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 Central Montana Medical 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.