CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Cheshire Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,727
Cash Discount Price: $1,008
vs. Medicare Baseline: 1.86x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Cheshire Medical Center is $1,727. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,008. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.86x the Medicare baseline. Located in 580 Court Street, Keene, NH.

Cash / Self-Pay

$1,008

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,727

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: $1,008 (109%)

Insurance Median: $1,727 (186%)

Cash: $1,008 (109% of Medicare)

Ins. Median: $1,727 (186% 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
Aetna	$137 - $2,608	15%
Blue Cross Blue Shield	$310 - $3,179	33%
Amerihealth Caritas Nh	$325 - $467	35%
Granite State Health Plan	$325 - $637	35%
Wellsense Health Plan	$325 - $1,048	35%
Ambetter / Centene	$409 - $871	44%
Cigna	$409 - $4,099	44%
Martin'S Point Generations Advantage	$409 - $980	44%
Mvp	$409 - $4,099	44%
UnitedHealthcare	$409 - $2,894	44%
Wellcare Health Plans	$409 - $980	44%
Martin'S Point Health Care	$549 - $980	59%
Mass General Brigham Health Plan	$656 - $3,813	71%
Harvard Pilgrim Health Care Of Ne	$743 - $2,055	80%
Tufts Health Plan	$857 - $2,434	92%
Maine Community Health Options	$1,570 - $1,716	169%
First Health/Hcvm	$2,965 - $3,241	320%
Phcs	$3,139 - $3,432	339%

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 $1,008.
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 Cheshire Medical 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.