CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Tri Valley Health System

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $389
Cash Discount Price: $796
vs. Medicare Baseline: 0.42x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Tri Valley Health System is $389. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $796. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.42x the Medicare baseline. Located in 1305 West Highway 6/34, Cambridge, NE.

Cash / Self-Pay

$796

Average discount available for prompt cash payment at this facility.

Insurance Median

$389

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: $796 (86%)

Insurance Median: $389 (42%)

Cash: $796 (86% of Medicare)

Ins. Median: $389 (42% 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	$115 - $840	12%
Humana	$115 - $389	12%
Medica Mcr Adv	$115 - $389	12%
Medica Prime Sol	$115 - $389	12%
Tricare	$115 - $389	12%
Wellcare Mcr Adv - All Plans	$119 - $389	13%
Aetna	$121 - $866	13%
Great Plains Mcr Adv - All Plans	$121 - $408	13%
Medica Ifb Aco	$226 - $796	24%
Medica Chi Aco - All Other Plans	$233 - $796	25%
Medica Chi Open Access	$249 - $796	27%
Healthy Blue Mcaid - All Plans	$266 - $424	29%
Molina Mcaid - All Plans	$266 - $424	29%
UnitedHealthcare	$266 - $849	29%
Nebraska Total Care-All Plans	$268 - $424	29%
Amerigroup Mcaid - All Plans	$271 - $433	29%
Medica Ifb Open Access	$288 - $796	31%
Multiplan-All Plans	$372 - $866	40%
Midlands Choice-All Plans	$696 - $796	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 $796.
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 Tri Valley 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.