CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: OHSU Hospital and Clinics

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,028
Cash Discount Price: $2,180
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at OHSU Hospital and Clinics is $1,028. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,180. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.11x the Medicare baseline. Located in 3181 Sw Sam Jackson Park Road, Portland, OR.

Cash / Self-Pay

$2,180

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,028

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: $2,180 (235%)

Insurance Median: $1,028 (111%)

Cash: $2,180 (235% of Medicare)

Ins. Median: $1,028 (111% 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
Care Oregon	$407 - $1,202	44%
Intercommunity Health Network	$407 - $815	44%
Kaiser Foundation Hospitals	$407 - $2,368	44%
Medicare (plans)	$407 - $1,630	44%
Pacific Source	$407 - $2,609	44%
Humana	$509 - $1,080	55%
Trillium	$509 - $1,018	55%
Moda	$535 - $3,354	58%
UnitedHealthcare	$540 - $3,354	58%
Aetna	$550 - $2,616	59%
Health Net Health Plan Of Oregon, Inc.	$586 - $2,598	63%
Providence Health Plan	$611 - $3,354	66%
Community Health Plan Of Washington	$644 - $1,426	69%
Tuality Health	$917 - $1,833	99%
Samaritan Health Plan	$1,273 - $2,546	137%
Blue Cross Blue Shield	$1,410 - $2,821	152%
Cigna	$1,533 - $3,066	165%
Coventry First Health	$2,516	272%
First Choice	$2,541	274%
Molina Exchange	$3,354	362%

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 $2,180.
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 OHSU Hospital and Clinics 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.