CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Regional West Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $989
Cash Discount Price: $2,073
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Regional West Medical Center is $989. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,073. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.07x the Medicare baseline. Located in 4021 Ave B, Scottsbluff, NE.

Cash / Self-Pay

$2,073

Average discount available for prompt cash payment at this facility.

Insurance Median

$989

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: $2,073 (224%)

Insurance Median: $989 (107%)

Cash: $2,073 (224% of Medicare)

Ins. Median: $989 (107% 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
Aetna	$115 - $3,213	12%
Humana	$115 - $942	12%
Medica	$115 - $2,937	12%
Medica Cost	$121 - $989	13%
Wellcare	$121 - $989	13%
Naphcare	$173 - $1,413	19%
Winhealth	$219 - $2,937	24%
Ambetter / Centene	$269 - $1,413	29%
Cigna	$317 - $3,109	34%
Rci Insurance Group	$317 - $2,902	34%
UnitedHealthcare	$465 - $3,109	50%
Blue Cross Blue Shield	$696 - $2,764	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 $2,073.
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 Regional West 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.