CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Saint Alphonsus Medical Center - Nampa
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $99
- Cash Discount Price: $301
- vs. Medicare Baseline: 0.11x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Saint Alphonsus Medical Center - Nampa is $99. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $301. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.11x the Medicare baseline. Located in 4300 E Flamingo Ave, Nampa, ID.
Cash / Self-Pay
$301
Average discount available for prompt cash payment at this facility.
Insurance Median
$99
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: $301 (32%)
Insurance Median: $99 (11%)
Cash: $301 (32% of Medicare)
Ins. Median: $99 (11% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $54 - $354 | 6% |
| Oregon Screenwise | $54 | 6% |
| Aetna | $57 - $989 | 6% |
| Align Senior Care | $57 | 6% |
| Ally Align Care Adv | $57 | 6% |
| American Health Plan | $57 | 6% |
| Aurora Special Needs | $57 | 6% |
| Blue Care Network Advantage | $57 | 6% |
| Blue Cross Blue Shield | $57 - $1,077 | 6% |
| Blue Shield - De (Highmark) Medciare Advantage | $57 | 6% |
| Care Dimensions | $57 | 6% |
| Care Improvement Plus | $57 | 6% |
| Care Resources Pace | $57 | 6% |
| Careplus Health Plans | $57 | 6% |
| Cca - Zing Health | $57 | 6% |
| Cca Senior Care Options | $57 | 6% |
| Central Valley Medical Services Corp Pace | $57 | 6% |
| Champion Health Plan Mcr Advantage | $57 | 6% |
| Cigna | $57 - $9,000 | 6% |
| Clear Spring Health | $57 | 6% |
| Clover Health | $57 | 6% |
| Commonwealth Care Alliance | $57 | 6% |
| Community Pace At Home | $57 | 6% |
| Eddy Senior Care-Pace | $57 | 6% |
| Eddy Seniorcare Pace | $57 | 6% |
| Elementcare | $57 | 6% |
| Evercare | $57 | 6% |
| Everence | $57 | 6% |
| Gateway Health Plan | $57 | 6% |
| Genesys Pace Of Genesee County | $57 | 6% |
| Georgia Health Advantage | $57 | 6% |
| Gold Advantage | $57 | 6% |
| Gpa Croell Redi Mix | $57 | 6% |
| Health America Advantra | $57 | 6% |
| Highmark Health Options Dual Plan | $57 | 6% |
| Hope Select Pace | $57 | 6% |
| Horizon Nj Total Care | $57 | 6% |
| Hudson Headwaters Pace | $57 | 6% |
| Humana | $57 - $228 | 6% |
| Huron Valley Pace | $57 | 6% |
| Innovative Integrated Health Community Plans | $57 | 6% |
| Iowa Health Advantage | $57 | 6% |
| Johns Hopkins Advantage Md | $57 | 6% |
| Lasso Healthcare Msa | $57 | 6% |
| Life St Marys Pace | $57 | 6% |
| Lifecircles Pace | $57 | 6% |
| Longevity Health Plan | $57 | 6% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $57 | 6% |
| Martins Point Generations Advantage | $57 | 6% |
| Mass General Brigham Mcr Adv | $57 | 6% |
| Medicare (plans) | $57 - $1,009 | 6% |
| Medipak Advantage | $57 | 6% |
| Mercy Life | $57 | 6% |
| Mercyone Cedar Valley | $57 | 6% |
| Meridian Complete | $57 | 6% |
| Michigan Complete Health | $57 | 6% |
| Nascentia Health Plus | $57 | 6% |
| New Centry Health Careplus | $57 | 6% |
| Osu Prime Care Advantage | $57 | 6% |
| Pace Cny | $57 | 6% |
| Pace Iowa Immanuel Pathways | $57 | 6% |
| Pace Of Southwest Michigan | $57 - $99 | 6% |
| Pace Southeast | $57 | 6% |
| Pace-Trinity Health | $57 | 6% |
| Peak Pace Solutions | $57 | 6% |
| Perennial Advantage | $57 | 6% |
| Preferred Care Partners | $57 | 6% |
| Presbyterian Senior Plan | $57 | 6% |
| Provider Partners Health Plan Of Illinois | $57 | 6% |
| Provider Partners Health Plan Of Indiana | $57 | 6% |
| Pruitthealth Premier | $57 | 6% |
| Reliance Community Care Partners Care Resources Pace | $57 | 6% |
| Rx Allwin | $57 | 6% |
| Rx Grane Grnmedd | $57 | 6% |
| Rx Retiree Rx Care | $57 | 6% |
| Scan Health Plan Mcr Ipa Meritage Oon | $57 | 6% |
| Secure Horizons Ma Pffs | $57 | 6% |
| Serenity Pace | $57 | 6% |
| Siouxland Pace | $57 | 6% |
| Solis Health Plans | $57 | 6% |
| Sunnyview-Pace Finance Dept | $57 | 6% |
| Texan Plus | $57 | 6% |
| The Health Plan | $57 | 6% |
| Thome Pace | $57 | 6% |
| Todays Options | $57 | 6% |
| Tribute Health Plans | $57 | 6% |
| Um Health Advantage | $57 | 6% |
| Union Health Service | $57 | 6% |
| UnitedHealthcare | $57 - $960 | 6% |
| Welbe Health | $57 | 6% |
| Wellmed | $57 | 6% |
| Veterans Administration | $58 | 6% |
| American Health Advantage Of Idaho | $59 - $998 | 6% |
| Champva | $62 | 7% |
| Tricare | $62 | 7% |
| Triwest Health Alliance | $62 | 7% |
| Us Family Health Plan | $62 | 7% |
| Veterans Eval Services | $62 | 7% |
| Albany County Correctional Facility | $99 | 11% |
| Ambetter / Centene | $99 | 11% |
| Amish Mennonite | $99 | 11% |
| Ascension St. Vincent Public Safety Medical | $99 | 11% |
| Bcccp-Michigan | $99 | 11% |
| Bccp | $99 | 11% |
| Bmc Healthnet | $99 | 11% |
| Breast Grant-Connecticut | $99 | 11% |
| Broward County Dept Of Health | $99 | 11% |
| California Health And Wellness | $99 | 11% |
| Can Community Health Inc | $99 | 11% |
| Cardinal Innovations Lme | $99 | 11% |
| Care Connections Of Northern Iowa | $99 | 11% |
| Care Oregon Ohp | $99 | 11% |
| Cencal Health Plan | $99 | 11% |
| Cenpatico | $99 | 11% |
| Centurion Of Idaho | $99 | 11% |
| Chhuny | $99 | 11% |
| Childrens Comm Health Plan | $99 | 11% |
| Childrens Medical Services Title 19 | $99 | 11% |
| City Of Philadelphia | $99 | 11% |
| Cmh Allegan County | $99 | 11% |
| Cmh Ausable Valley | $99 | 11% |
| Cmh Barry County | $99 | 11% |
| Cmh Bay-Arenac County | $99 | 11% |
| Cmh Berrien County | $99 | 11% |
| Cmh Cass County | $99 | 11% |
| Cmh Central Mi County | $99 | 11% |
| Cmh Clinton-Eaton-Ingham County | $99 | 11% |
| Cmh Detroit Wayne Integrated Health Network | $99 | 11% |
| Cmh Genesee County | $99 | 11% |
| Cmh Ionia County | $99 | 11% |
| Cmh Jackson County/Lifeways | $99 | 11% |
| Cmh Kalamazoo | $99 | 11% |
| Cmh Kent County | $99 | 11% |
| Cmh Lenawee County | $99 | 11% |
| Cmh Livingston County | $99 | 11% |
| Cmh Macomb | $99 | 11% |
| Cmh Misc | $99 | 11% |
| Cmh Monroe County | $99 | 11% |
| Cmh Montcalm County | $99 | 11% |
| Cmh Muskegon County | $99 | 11% |
| Cmh Newaygo County | $99 | 11% |
| Cmh North Country | $99 | 11% |
| Cmh Northern Lakes County | $99 | 11% |
| Cmh Oakland County | $99 | 11% |
| Cmh Ottawa County | $99 | 11% |
| Cmh Van Buren County | $99 | 11% |
| Cmh Washtenaw County | $99 | 11% |
| Cmh Wayne County/Carelink | $99 | 11% |
| Cmh Wayne Cty/Com Liv Svcs | $99 | 11% |
| Cmh West Mi County | $99 | 11% |
| Community Benefit Health | $99 | 11% |
| Community Care Behavorial Health | $99 | 11% |
| Community Care Partners | $99 | 11% |
| Community Health Choice | $99 | 11% |
| Connections Csp | $99 | 11% |
| County Coroner | $99 | 11% |
| County Funding Generic | $99 | 11% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $99 | 11% |
| Dean Wi Badgercare | $99 | 11% |
| Delaware County Department Of Health | $99 | 11% |
| Delaware First Health | $99 | 11% |
| Delta Dental Nj | $99 | 11% |
| Dph Tb Program | $99 | 11% |
| Dscc | $99 | 11% |
| Eastpointe Lme | $99 | 11% |
| Family Health Network | $99 | 11% |
| Freedom First Healthcare | $99 | 11% |
| Fresno County Ccs | $99 | 11% |
| Ghc Scw Wi Badgercare | $99 | 11% |
| Harbor Health | $99 | 11% |
| Health Safety Net | $99 | 11% |
| Healthy Blue Ne | $99 | 11% |
| Hennepin Health | $99 | 11% |
| Id County Ada | $99 | 11% |
| Id County Canyon | $99 | 11% |
| Id County Cat Fund | $99 | 11% |
| Id County Other | $99 | 11% |
| Id County Payette | $99 | 11% |
| Idaho Dept Health And Wellfare | $99 | 11% |
| Idaho Womens Health Check | $99 | 11% |
| Indiana Breast Cervical Cancer | $99 | 11% |
| Inland Empire Health Plan | $99 | 11% |
| Intercommunity Health Ohp | $99 | 11% |
| Iowa Total Care | $99 | 11% |
| Jai Medical System | $99 | 11% |
| Kern Family Health Plan | $99 | 11% |
| Keystone First | $99 | 11% |
| Keystone First Chip | $99 | 11% |
| La Care Health Plan | $99 | 11% |
| Lakeland Care Inc | $99 | 11% |
| Managed Health Services - Indiana | $99 | 11% |
| Maryland Breast & Cervical Program | $99 | 11% |
| Maryland Healthy Smiles - Scion Dental | $99 | 11% |
| Maryland Physicians Care | $99 | 11% |
| Massachusetts Behavioral Health Partnership | $99 | 11% |
| Mdwise | $99 | 11% |
| Medi-Cal | $99 | 11% |
| Medi-Cal Healthnet | $99 | 11% |
| Medstar Dc Healthy Family | $99 | 11% |
| Medstar Md Health Choice | $99 | 11% |
| Mo Home State Health Plan | $99 | 11% |
| Molina Centennial Care | $99 | 11% |
| Nascentia Health Options | $99 | 11% |
| Nebraska Total Care | $99 | 11% |
| New York Cancer Services Program | $99 | 11% |
| Nextlevel Health | $99 | 11% |
| Paramount Advantage | $99 | 11% |
| Parkland Community Health Plan | $99 | 11% |
| Partners Behavioral Lme | $99 | 11% |
| Peach State Healthplan | $99 | 11% |
| Philadelphia County Funding | $99 | 11% |
| Presbyterian Centennial Care | $99 | 11% |
| Prestige Health Choice | $99 | 11% |
| Priority Partners | $99 | 11% |
| Robert F Sing Program | $99 | 11% |
| Rx 340B Pass Along | $99 | 11% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $99 | 11% |
| Rx Medi-Cal | $99 | 11% |
| Rx Meridian Rx | $99 | 11% |
| Ryan White Florida Mssrp | $99 | 11% |
| Sandhills Center Lme | $99 | 11% |
| Screening For Life | $99 | 11% |
| St Joseph County Hlth Dpt | $99 | 11% |
| Stephenson Cty Health | $99 | 11% |
| Sunshine State Health Plan | $99 | 11% |
| Superior Health | $99 | 11% |
| Tenncare | $99 | 11% |
| Texas Children'S Health Plan | $99 | 11% |
| Trillium Community Ohp | $99 | 11% |
| Tufts Health Public Plans | $99 | 11% |
| Vaya Health Lme | $99 | 11% |
| Washtenaw Health Plan | $99 | 11% |
| Wellsense Health Plan | $99 | 11% |
| Wi Womens Wellness | $99 | 11% |
| Meritain | $101 | 11% |
| Webtpa | $104 - $2,585 | 11% |
| Molina Marketplace | $113 - $2,311 | 12% |
| Providence | $116 - $9,000 | 13% |
| Healthnet | $128 - $229 | 14% |
| Pacificsource Health Plans | $131 - $176 | 14% |
| Blue Shield - Id (Regence) | $132 - $864 | 14% |
| Moda Health | $132 - $1,902 | 14% |
| Mountain Health Co-Op | $132 | 14% |
| Selecthealth | $132 - $1,591 | 14% |
| Bcn Domestic | $137 | 15% |
| Blue Benefit Administrators Of Massachusetts | $137 | 15% |
| Blue Care Network | $137 | 15% |
| Blue Distinction Transplant | $137 | 15% |
| Blue Shield - Ca | $137 | 15% |
| Blue Shield - Ny Highmark Northeastern | $137 | 15% |
| Blue Shield - Ny Highmark Western | $137 | 15% |
| Blue Shield - Pa (Highmark) | $137 | 15% |
| Blue Shield - Wa (Regence) | $137 - $826 | 15% |
| Health Choices | $137 | 15% |
| Kaiser Domestic | $137 | 15% |
| Pre-Employment | $137 | 15% |
| Wc Domestic | $137 | 15% |
| Health Plans Inc | $141 | 15% |
| Ms Administrative Services | $141 | 15% |
| Asuris Northwest Health | $145 - $826 | 16% |
| Healthcare Management Admin | $145 - $826 | 16% |
| Geha | $148 | 16% |
| Andrie Inc | $161 | 17% |
| East Greenbush Central School District | $161 | 17% |
| Genex Wc | $161 | 17% |
| Healthsmart Workers Comp | $161 | 17% |
| Jag Source | $161 | 17% |
| New York State Insurance Fund | $161 | 17% |
| Njm Insurance Group | $161 | 17% |
| Rx Heatlhcomp | $161 | 17% |
| Rx Restat | $161 | 17% |
| Rx Saif Opdp Wc | $161 | 17% |
| Rx Worker'S Comp | $161 | 17% |
| Wc Accident Fund | $161 | 17% |
| Wc Ace | $161 | 17% |
| Wc Acs Federal Employees | $161 | 17% |
| Wc Acuity | $161 | 17% |
| Wc Advantage | $161 | 17% |
| Wc Aegis | $161 | 17% |
| Wc Aig | $161 | 17% |
| Wc Aims | $161 | 17% |
| Wc Alaska National Ins | $161 | 17% |
| Wc Align Network | $161 | 17% |
| Wc Allied | $161 | 17% |
| Wc Am Trust N America | $161 | 17% |
| Wc American Claims Mgmt | $161 | 17% |
| Wc Amerisure | $161 | 17% |
| Wc Amtrust | $161 | 17% |
| Wc Asu Risk Mgt | $161 | 17% |
| Wc Benetech | $161 | 17% |
| Wc Berkley Admin | $161 | 17% |
| Wc Broadspire | $161 | 17% |
| Wc Broward County | $161 | 17% |
| Wc Bunch & Associates | $161 | 17% |
| Wc California State Comp Ins | $161 | 17% |
| Wc California State Ins Fund | $161 | 17% |
| Wc Capitol Area Health Consortium | $161 | 17% |
| Wc Ccmsi | $161 | 17% |
| Wc Chartis | $161 | 17% |
| Wc Chubb | $161 | 17% |
| Wc Cirma | $161 | 17% |
| Wc City Of Albany | $161 | 17% |
| Wc City Of Sioux City | $161 | 17% |
| Wc Claims Mgmt Inc | $161 | 17% |
| Wc Cna | $161 | 17% |
| Wc Comp One Admin C/O Manageability | $161 | 17% |
| Wc Compone Admin | $161 | 17% |
| Wc Corvel | $161 | 17% |
| Wc Ct Healthcare Trust | $161 | 17% |
| Wc Donegal Insurance Group | $161 | 17% |
| Wc Emc Insurance Company | $161 | 17% |
| Wc Employee Mutual | $161 | 17% |
| Wc Enablecomp | $161 | 17% |
| Wc Encore Health Network | $161 | 17% |
| Wc Erie | $161 | 17% |
| Wc Esis | $161 | 17% |
| Wc Evolutions | $161 | 17% |
| Wc Fcci | $161 | 17% |
| Wc Fed Ex | $161 | 17% |
| Wc Federal Black Lung | $161 | 17% |
| Wc Federated | $161 | 17% |
| Wc Finley Occupational Health | $161 | 17% |
| Wc First Agency/Occunet | $161 | 17% |
| Wc Ford Motor | $161 | 17% |
| Wc Fresno Unified Emp | $161 | 17% |
| Wc Gallagher Bassett | $161 | 17% |
| Wc General Motors | $161 | 17% |
| Wc Generic | $161 | 17% |
| Wc Genex Care For Ohio | $161 | 17% |
| Wc Great West Casualty | $161 | 17% |
| Wc Guarantee Insurance | $161 | 17% |
| Wc Guard Insurance Company | $161 | 17% |
| Wc Hab | $161 | 17% |
| Wc Hartford | $161 | 17% |
| Wc Hastings | $161 | 17% |
| Wc Health Management | $161 | 17% |
| Wc Heritage Summit | $161 | 17% |
| Wc Hireright | $161 | 17% |
| Wc Horizon | $161 | 17% |
| Wc Icw Group | $161 | 17% |
| Wc Idaho State Ins Fund | $161 | 17% |
| Wc Intercare Insurance | $161 | 17% |
| Wc Intermountain | $161 | 17% |
| Wc Johns Eastern | $161 | 17% |
| Wc Kemberton | $161 | 17% |
| Wc Key Ins & Benefit Solutions | $161 | 17% |
| Wc Liberty Mutual | $161 | 17% |
| Wc Mac Risk Management | $161 | 17% |
| Wc Massachusetts | $161 | 17% |
| Wc Mdia | $161 | 17% |
| Wc Meadowbrook Claim | $161 | 17% |
| Wc Medical Administrators | $161 | 17% |
| Wc Meijers | $161 | 17% |
| Wc Memic | $161 | 17% |
| Wc Mercy Workcare | $161 | 17% |
| Wc Michigan | $161 | 17% |
| Wc Michigan Millers Mutual | $161 | 17% |
| Wc Mitchell Frankenmuth | $161 | 17% |
| Wc Mra | $161 | 17% |
| Wc Nationwide | $161 | 17% |
| Wc Nca Comp | $161 | 17% |
| Wc New York | $161 | 17% |
| Wc New York Special Funds | $161 | 17% |
| Wc North American Rishces | $161 | 17% |
| Wc Northeast Health | $161 | 17% |
| Wc Notre Dame | $161 | 17% |
| Wc Novanet | $161 | 17% |
| Wc O'Hara Corp | $161 | 17% |
| Wc Occ Health Allen | $161 | 17% |
| Wc Ohio Bureau | $161 | 17% |
| Wc One Call Medical | $161 | 17% |
| Wc Paradigm | $161 | 17% |
| Wc Peerless | $161 | 17% |
| Wc Pma | $161 | 17% |
| Wc Praxis Health Network | $161 | 17% |
| Wc Price Chopper | $161 | 17% |
| Wc Procura Management | $161 | 17% |
| Wc Qualcare | $161 | 17% |
| Wc Quiktrip | $161 | 17% |
| Wc Reny Company | $161 | 17% |
| Wc Rev Claims | $161 | 17% |
| Wc Risico | $161 | 17% |
| Wc Rural Mutual | $161 | 17% |
| Wc Saif Oregon | $161 | 17% |
| Wc Secura | $161 | 17% |
| Wc Sedgwick | $161 | 17% |
| Wc Sentry | $161 | 17% |
| Wc Sheakley Unicomp | $161 | 17% |
| Wc Smile Lodge | $161 | 17% |
| Wc Society | $161 | 17% |
| Wc Srs | $161 | 17% |
| Wc Taconic (Mro) | $161 | 17% |
| Wc Taconic Farms | $161 | 17% |
| Wc Travelers | $161 | 17% |
| Wc Triad Group | $161 | 17% |
| Wc Tristar | $161 | 17% |
| Wc Troy Ny | $161 | 17% |
| Wc Tyson | $161 | 17% |
| Wc Unified Health Services | $161 | 17% |
| Wc United Heartland | $161 | 17% |
| Wc Us Dept Of Labor | $161 | 17% |
| Wc Velocity | $161 | 17% |
| Wc Walmart | $161 | 17% |
| Wc West Bend | $161 | 17% |
| Wc West Bend Mutual/Argent | $161 | 17% |
| Wc Winnebago Industries | $161 | 17% |
| Wc Yankee Trails | $161 | 17% |
| Wc York Risk | $161 | 17% |
| Wc Zenith | $161 | 17% |
| Wc Zurich | $161 | 17% |
| Allied National Global Care | $169 | 18% |
| Asrm - Reliance Standard Life Insurance | $169 | 18% |
| Christian Care Ministry | $169 | 18% |
| Dean Health | $169 | 18% |
| Fallon Health | $169 | 18% |
| Family Life Insurance Company | $169 | 18% |
| Ghc Scw | $169 | 18% |
| International Benefit Administrators | $169 | 18% |
| Lifetime Benefit Solutions | $169 | 18% |
| Manhattan Life | $169 | 18% |
| Medi Share | $169 | 18% |
| Multiplan | $169 | 18% |
| Pai | $169 | 18% |
| Pan-American Life | $169 | 18% |
| Paramount Hmo | $169 | 18% |
| Phcs | $169 | 18% |
| Trinity Health Share | $169 | 18% |
| Allegiance | $197 | 21% |
| First Choice Health | $208 | 22% |
| Prime Healthcare | $1,760 | 190% |
| Priority Health | $9,000 | 971% |