CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Springfield Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,610
Cash Discount Price: $2,312
vs. Medicare Baseline: 1.74x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Springfield Hospital is $1,610. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,312. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.74x the Medicare baseline. Located in Po Box 2003, Springfield, VT.

Cash / Self-Pay

$2,312

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,610

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: $2,312 (250%)

Insurance Median: $1,610 (174%)

Cash: $2,312 (250% of Medicare)

Ins. Median: $1,610 (174% 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
Blue Cross Blue Shield	$505 - $4,835	54%
Mvp Health Plan	$505 - $3,723	54%
UnitedHealthcare	$505 - $4,352	54%
Wellsense	$505 - $4,835	54%
Harvard Pilgrim Health Care	$510 - $4,000	55%
Wellcare	$520 - $1,892	56%
Tufts Health Plan	$817 - $2,971	88%
Cigna	$933 - $5,028	101%
Multiplan	$1,103 - $4,013	119%
Aetna	$1,263 - $4,593	136%
Coventry	$1,263 - $4,593	136%
Beacon Health	$1,329 - $4,835	143%
Manage Behavioral Health	$1,329 - $4,835	143%
Martin'S Point Healthcare	$1,329 - $4,835	143%

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 $2,312.
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 Springfield 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.