CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Alice Peck Day Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,185
Cash Discount Price: $1,086
vs. Medicare Baseline: 1.28x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Alice Peck Day Memorial Hospital is $1,185. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,086. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.28x the Medicare baseline. Located in 10 Alice Peck Day Drive, Lebanon, NH.

Cash / Self-Pay

$1,086

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,185

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: $1,086 (117%)

Insurance Median: $1,185 (128%)

Cash: $1,086 (117% of Medicare)

Ins. Median: $1,185 (128% 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
Ambetter / Centene	$126	14%
Nh Healthy Families	$131	14%
Medicaid / KanCare	$547 - $1,303	59%
Blue Cross Blue Shield	$589 - $2,527	64%
Harvard Pilgrim	$741 - $2,461	80%
UnitedHealthcare	$858 - $2,044	93%
Tufts	$873 - $2,082	94%
Cigna	$912 - $2,322	98%
Commercial Generic	$912 - $2,175	98%
Connecticut General	$912 - $2,175	98%
Klais	$921 - $2,195	99%
Wellpoint	$936 - $2,231	101%
Aetna	$1,072 - $2,555	116%
Mvp	$1,084 - $2,583	117%
Coventry Health	$1,131 - $2,697	122%
Coventry Health Wc	$1,131 - $2,697	122%
Humana	$1,239 - $2,953	134%

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 $1,086.
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 Alice Peck Day 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.