CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Kona Community Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,135
Cash Discount Price: $2,681
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Kona Community Hospital is $1,135. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,681. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.22x the Medicare baseline. Located in 79-1019 Haukapila Street, Kealakekua, HI.

Cash / Self-Pay

$2,681

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,135

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: $2,681 (289%)

Insurance Median: $1,135 (122%)

Cash: $2,681 (289% of Medicare)

Ins. Median: $1,135 (122% 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
UnitedHealthcare	$456 - $1,135	49%
Hmsa	$479 - $5,830	52%
Hawaii Medical Service Association	$695 - $6,183	75%
Kaiser Permanente	$938 - $2,857	101%
Alohacare	$1,071 - $1,135	116%
Humana	$1,071 - $1,135	116%
Ohana Health Plan	$1,071 - $1,179	116%
Kaiser	$1,135 - $2,837	122%
Ohana	$1,135 - $1,248	122%
Devoted Health	$1,179	127%
Hma	$3,011	325%
Health Management Network	$3,855	416%
Hmaa	$4,024	434%
Hawaii Western Management Group	$4,308	465%
Mdx Hawaii	$4,399	475%
Uha	$4,492	485%
University Health Alliance	$5,160	557%

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 $2,681.
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 Kona Community 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.