CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Cherry County Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,364
Cash Discount Price: $1,899
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Cherry County Hospital is $1,364. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,899. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.47x the Medicare baseline. Located in 510 North Green St, Valentine, NE.

Cash / Self-Pay

$1,899

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,364

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: $1,899 (205%)

Insurance Median: $1,364 (147%)

Cash: $1,899 (205% of Medicare)

Ins. Median: $1,364 (147% 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
Molina Mcr Adv	$121 - $1,306	13%
Avera Hmo	$160 - $2,321	17%
Ambetter / Centene	$183	20%
Midwest Ntwrk Profee Only - All Plans	$230	25%
Oscar Profee Only - All Plans	$230	25%
Avera Aca Ppo	$266 - $2,321	29%
Molina Mcaid - All Other Plans	$271 - $1,489	29%
Midlands Choice-All Plans	$274 - $2,297	30%
Avera Aso Ppo	$282 - $2,321	30%
Avera Non-Aca Ppo - All Other Plans	$294 - $2,321	32%
UnitedHealthcare	$369 - $2,309	40%
First Choice-All Plans	$1,364 - $2,321	147%
Multiplan-All Plans	$1,364 - $2,321	147%
Phcs-All Plans	$1,364 - $2,321	147%
Tlc Advantage-All Plans	$1,364 - $2,321	147%
Blue Cross Blue Shield	$2,297	248%

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 $1,899.
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 Cherry County 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.