CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Phelps Memorial Health Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,920
Cash Discount Price: $1,728
vs. Medicare Baseline: 2.07x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Phelps Memorial Health Center is $1,920. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,728. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.07x the Medicare baseline. Located in 1215 Tibbals St, Holdrege, NE.

Cash / Self-Pay

$1,728

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,920

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: $1,728 (186%)

Insurance Median: $1,920 (207%)

Cash: $1,728 (186% of Medicare)

Ins. Median: $1,920 (207% 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 207% of the Medicare baseline (a markup of 107%). 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
Blue Cross Blue Shield	$115 - $4,937	12%
Good Samaritan Mcr Adv - All Plans	$115 - $2,235	12%
Medica Mcr Adv	$115 - $2,235	12%
UnitedHealthcare	$115 - $5,041	12%
Va Ccn - All Plans	$115 - $2,235	12%
Wellcare Mcr Adv - All Plans	$115 - $2,235	12%
Three Rivers - All Plans	$138 - $2,682	15%
Provider Network Of American - All Plans	$173 - $4,833	19%
Partners Hlth Alliance - All Plans	$202 - $4,158	22%
6 Degrees Hlth - All Plans	$207 - $4,158	22%
Medica-All Other Plans	$207 - $4,885	22%
Ambetter / Centene	$209 - $5,810	23%
Midwest Ntwrk Alliance - All Plans	$219 - $4,937	24%
Aetna	$374 - $4,792	40%
Providrs Care/Wppa - All Plans	$392 - $4,677	42%
First Health - All Plans	$1,537 - $4,942	166%
Molina Mcaid - All Plans	$1,616 - $2,287	174%
Cpi Benefit Group-All Plans	$4,677	505%
Chi Health Partners - All Plans	$4,937	533%

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 $1,728.
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 Phelps Memorial Health 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.