CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Osmond General Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,190
Cash Discount Price: $3,000
vs. Medicare Baseline: 2.36x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Osmond General Hospital is $2,190. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,000. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.36x the Medicare baseline. Located in 402 North Maple St, Osmond, NE.

Cash / Self-Pay

$3,000

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,190

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: $3,000 (324%)

Insurance Median: $2,190 (236%)

Cash: $3,000 (324% of Medicare)

Ins. Median: $2,190 (236% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 236% of the Medicare baseline (a markup of 136%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Total Care Mcaid-All Plans	$1,560	168%
UnitedHealthcare	$1,560 - $2,769	168%
Wellcare Mcaid-All Plans	$1,560	168%
Blue Cross Blue Shield	$2,190 - $2,880	236%
Medica Mcr	$2,190	236%
Tricare	$2,190	236%
Triwest Va-All Plans	$2,190	236%
Coventry First Health	$2,820	304%
Coventry Ppo/Hmo/Pos/Aso - All Other Plans	$2,820	304%
Midlands Choice-All Plans	$2,880	311%
Medica-All Other Plans	$2,955	319%

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 $3,000.
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 Osmond General 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.