CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Bella Vista Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $403
Cash Discount Price: $200
vs. Medicare Baseline: 0.43x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Bella Vista Hospital is $403. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $200. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.43x the Medicare baseline. Located in Carr 349 Km 2 7 Cerro Las Mesas, Mayaguez, PR.

Cash / Self-Pay

$200

Average discount available for prompt cash payment at this facility.

Insurance Median

$403

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: $200 (22%)

Insurance Median: $403 (43%)

Cash: $200 (22% of Medicare)

Ins. Median: $403 (43% 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
Triple S Vital	$127	14%
Mcs	$130	14%
Plan Salud Menonita	$130	14%
First Medical Vital	$132	14%
Plan Salud Menonita Vital	$132 - $139	14%
Triple S	$132	14%
International Medical Card	$145	16%
Medicare (plans)	$150 - $696	16%
Mapfre Life Insurance Life Insurance	$161	17%
Servicios De Salud Bella Vista	$170 - $175	18%
Asociacion Maestros (Prossam)	$225	24%
Champva	$403 - $630	43%
Tricare	$403 - $696	43%
Triple S Advantage	$403 - $630	43%
UnitedHealthcare	$403 - $696	43%
Preferred Medical Choice(Pmc)	$657 - $696	71%

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 $200.
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 Bella 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.