CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,359
Cash Discount Price: $1,186
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Mary Hitchcock Memorial Hospital is $1,359. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,186. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.47x the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.

Cash / Self-Pay

$1,186

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,359

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: $1,186 (128%)

Insurance Median: $1,359 (147%)

Cash: $1,186 (128% of Medicare)

Ins. Median: $1,359 (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
Harvard Pilgrim Health Care Of Ne	$99 - $3,664	11%
UnitedHealthcare	$133 - $8,280	14%
Ambetter / Centene	$316 - $2,257	34%
Amerihealth Caritas Nh	$325 - $446	35%
Beacon Health Strategies/Carelon	$325 - $481	35%
Granite State Health Plan	$325 - $496	35%
Wellsense Health Plan	$325 - $1,102	35%
Cigna	$337 - $4,214	36%
Mass General Brigham Health Plan	$376 - $2,450	41%
Martin'S Point Health Care	$439 - $1,359	47%
Mvp	$469 - $2,654	51%
Tufts Health Plan	$481 - $2,298	52%
Blue Cross Blue Shield	$492 - $4,082	53%
Martin'S Point Generations Advantage	$494 - $1,049	53%
Aetna	$509 - $2,765	55%
Wellcare Health Plans	$514 - $1,091	55%
Maine Community Health Options	$2,429 - $2,895	262%
Coventry	$3,317 - $3,427	358%
First Health/Hcvm	$3,317 - $3,427	358%
Phcs	$3,432 - $3,545	370%
Corvel	$3,508 - $3,624	379%
Ccmsi	$3,622 - $3,742	391%

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 $1,186.
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 Mary Hitchcock Memorial 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.