CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Porter Hospital Inc

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $568
Cash Discount Price: $2,254
vs. Medicare Baseline: 0.61x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Porter Hospital Inc is $568. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,254. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.61x the Medicare baseline. Located in 115 Porter Drive, Middlebury, VT.

Cash / Self-Pay

$2,254

Average discount available for prompt cash payment at this facility.

Insurance Median

$568

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: $2,254 (243%)

Insurance Median: $568 (61%)

Cash: $2,254 (243% of Medicare)

Ins. Median: $568 (61% 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
Wellpath	$66 - $2,150	7%
Coventry	$78 - $3,441	8%
Blue Cross Blue Shield	$93 - $3,685	10%
Mvp	$109 - $3,644	12%
Medical Corporation	$114 - $3,714	12%
Multiplan	$114 - $3,714	12%
Fidelis Care	$115 - $1,654	12%
Veterans Affairs Community Care Network	$120 - $1,838	13%
Humana	$121 - $891	13%
Aetna	$128 - $1,838	14%
Veterans Choice	$128 - $1,838	14%
Harvard Pilgrim	$152 - $3,128	16%
UnitedHealthcare	$234 - $3,871	25%
Capital District Physicians' Health Plan	$341 - $3,261	37%
Martins Point	$351 - $1,838	38%
Cigna	$577 - $3,556	62%

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 $2,254.
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 Porter Hospital Inc 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.