CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: North Vista Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,210
Cash Discount Price: $986
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at North Vista Hospital is $1,210. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $986. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.31x the Medicare baseline. Located in 1409 East Lake Mead Blvd, North Las Vegas, NV.

Cash / Self-Pay

$986

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,210

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: $986 (106%)

Insurance Median: $1,210 (131%)

Cash: $986 (106% of Medicare)

Ins. Median: $1,210 (131% 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
Medicaid / KanCare	$326 - $329	35%
Blue Cross Blue Shield	$329 - $3,284	36%
Molina Healthcare	$329 - $987	36%
Silver Summit	$329 - $1,578	36%
Sierra Health	$455	49%
Triwest	$977	105%
Aetna	$987 - $1,210	107%
Intermountain Healthcare (Hcp)	$987 - $1,776	107%
Medicare (plans)	$987	107%
Renal Payor Solutions	$987	107%
Tricare	$987	107%
Alignment	$1,006	109%
Employer Direct Healthcare	$1,381	149%
Imperial Insurance Companies	$1,480 - $1,825	160%
Three Rivers	$1,508	163%
Naphcare	$1,529	165%
Provider Select	$1,539	166%
Worker Comp	$1,555	168%
Health Services Coalition	$1,874	202%
UnitedHealthcare	$1,875 - $1,967	202%
Nevada Health Partners	$1,887	204%
6 Degrees Health	$1,973	213%

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 $986.
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 North Vista 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.