CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: South Lincoln Medical Center - Cah

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,120
Cash Discount Price: $934
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at South Lincoln Medical Center - Cah is $1,120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $934. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.21x the Medicare baseline. Located in 711 Onyx Street, Kemmerer, WY.

Cash / Self-Pay

$934

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,120

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: $934 (101%)

Insurance Median: $1,120 (121%)

Cash: $934 (101% of Medicare)

Ins. Median: $1,120 (121% 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
Aetna	$246 - $1,581	27%
Blue Cross Blue Shield	$246 - $1,398	27%
Humana	$246 - $865	27%
Altius Health Plans - All Plans	$773 - $1,498	83%
Cigna	$773 - $1,498	83%
Great West Healthcare - All Plans	$773 - $1,498	83%
Integrated Hp - All Plans	$773 - $1,498	83%
UnitedHealthcare	$773 - $1,498	83%
Winhealth Partners - All Plans	$773 - $1,498	83%
Ccn - All Plans	$816 - $1,581	88%
Geha - All Plans	$816 - $1,581	88%
Health Infonet/First Choice - All Plans	$816 - $1,581	88%
Three Rivers - All Plans	$816 - $1,581	88%

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 $934.
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 South Lincoln Medical Center - Cah 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.