CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: St Luke's Nampa Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,021
Cash Discount Price: $2,526
vs. Medicare Baseline: 2.18x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at St Luke's Nampa Medical Center is $2,021. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,526. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.18x the Medicare baseline. Located in 9850 West St Lukes Drive, Nampa, ID.

Cash / Self-Pay

$2,526

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,021

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: $2,526 (273%)

Insurance Median: $2,021 (218%)

Cash: $2,526 (273% of Medicare)

Ins. Median: $2,021 (218% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 218% of the Medicare baseline (a markup of 118%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$962 - $2,071	104%
Blue Cross Blue Shield	$1,060 - $2,747	114%
Commercial [1028]	$1,060 - $2,747	114%
Mountain Health Co-Op [1067]	$1,060 - $1,642	114%
Pacificsource [1020]	$1,060 - $1,894	114%
Select Health [1063]	$1,060 - $1,642	114%
Slplan Tap Mc St Lukes Health Plan [1641000001]	$1,060 - $1,642	114%
St Lukes Health Plan [1046]	$1,060 - $1,642	114%
Aetna	$2,021 - $2,273	218%
Cigna	$2,021	218%
Providence [1022]	$2,021	218%
Webtpa [1071]	$2,021 - $2,147	218%
Geha [1065]	$2,071	223%
United Medical Resources [1051]	$2,071	223%
First Health [1064]	$2,084 - $2,147	225%
Moda [1055]	$2,223	240%
Blue Shield Alt [100401]	$2,747	296%
Regence Out Of State [1004]	$2,747	296%
Regence [1005]	$2,747	296%

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 $2,526.
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 St Luke's Nampa Medical Center 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.