CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Harlan County Health System

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,026
Cash Discount Price: $1,514
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Harlan County Health System is $1,026. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,514. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.11x the Medicare baseline. Located in 717 Brown St, Alma, NE.

Cash / Self-Pay

$1,514

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,026

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: $1,514 (163%)

Insurance Median: $1,026 (111%)

Cash: $1,514 (163% of Medicare)

Ins. Median: $1,026 (111% 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 - $1,330	12%
Medica Chi Health	$115 - $1,729	12%
Medica Mcr Adv	$115 - $1,026	12%
Medica Prime Solution	$115 - $1,026	12%
Tricare	$115 - $1,273	12%
UnitedHealthcare	$115 - $1,885	12%
Great Plains Mcr Adv-All Plans	$121 - $1,337	13%
Medica Ifb Aco	$209 - $1,824	23%
Blue Cross Blue Shield	$220 - $1,824	24%
Medica Chi Aco - All Other Plans	$220 - $1,729	24%
Medica Choice	$230 - $1,729	25%
Medica Ifb Open Access	$267 - $1,824	29%
Phcs/Multiplan-All Plans	$344 - $1,862	37%
Humana	$1,273	137%
Ohara Llc Wc- All Plans	$1,791 - $1,805	193%
Ambetter / Centene	$1,923	208%
Healthy Blue Mcaid-All Plans	$1,979	214%

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 $1,514.
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 Harlan County Health System 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.