CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Sunrise Hospital and Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $291
Cash Discount Price: $792
vs. Medicare Baseline: 0.31x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Sunrise Hospital and Medical Center is $291. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $792. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.31x the Medicare baseline. Located in 3186 S Maryland Pkwy, Las Vegas, NV.

Cash / Self-Pay

$792

Average discount available for prompt cash payment at this facility.

Insurance Median

$291

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: $792 (85%)

Insurance Median: $291 (31%)

Cash: $792 (85% of Medicare)

Ins. Median: $291 (31% 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
Amerigroup	$92 - $171	10%
Health Plan Nevada	$92 - $179	10%
Humana	$97 - $2,704	10%
Molina	$97 - $188	10%
Silver Summit	$97 - $445	10%
Healthcare Partners Of Nv	$129 - $486	14%
Aetna	$131 - $2,138	14%
Alignment Health Plan	$131 - $356	14%
Blue Cross Blue Shield	$131 - $3,720	14%
United	$135 - $2,295	15%
Caremore	$138 - $373	15%
Community Care Health	$140 - $329	15%
Molina Healthcare	$140 - $343	15%
Sierra Hpn	$140 - $329	15%
Hometown Health Providers	$151 - $2,339	16%
Culinary Health Fund	$165 - $533	18%
Sierra	$171 - $1,884	18%
Cigna	$172 - $2,482	19%
Multiplan	$175 - $3,500	19%
Select Health	$263 - $5,307	28%
Caresource	$343	37%
Legacy Provider Network	$1,068	115%
Corvel	$1,128 - $1,520	122%
Comp-Med Workers Comp	$1,151	124%
Olympus Medsave Usa	$1,187 - $1,600	128%
Ambetter / Centene	$2,550 - $2,626	275%
Health Services Coalition	$4,260	460%

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 $792.
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 Sunrise Hospital and 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.