CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Saint Mary's Regional Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,381
Cash Discount Price: $986
vs. Medicare Baseline: 1.49x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Saint Mary's Regional Medical Center is $1,381. 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 1.49x the Medicare baseline. Located in 235 W 6Th St, Reno, NV.

Cash / Self-Pay

$986

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,381

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: $1,381 (149%)

Cash: $986 (106% of Medicare)

Ins. Median: $1,381 (149% 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
Molina Healthcare Of Nv	$144 - $987	16%
Access To Healthcare Network	$280	30%
Blue Cross Blue Shield	$329 - $1,902	36%
Health Plan Of Nevada	$329 - $987	36%
Medicaid / KanCare	$329	36%
Silver Summit	$329 - $1,726	36%
Aetna	$987 - $2,444	107%
Medicare (plans)	$987	107%
Saint Mary Health Plan	$987 - $1,135	107%
Sierra	$987	107%
Tricare	$987	107%
Triwest	$987	107%
Alignment	$1,006	109%
UnitedHealthcare	$1,016 - $2,578	110%
Pam	$1,135	122%
Veterans Evaluation Service Ves	$1,233	133%
Employer Direct	$1,381	149%
Home Town Test	$1,381	149%
Naphcare	$1,381	149%
Asserta Health	$1,480	160%
Imperial Insurance Company	$1,480 - $1,825	160%
Occunet	$1,508 - $1,973	163%
Three Rivers	$1,508	163%
Worker Compensation	$1,555	168%
Nevada Health Partners	$1,833	198%
6 Degrees	$1,973	213%
Nv Preferred	$2,098 - $2,239	226%
Custom Ink	$2,141	231%

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 Saint Mary's Regional 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.