CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Hillsboro Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,008
Cash Discount Price: $2,180
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Hillsboro Medical Center is $1,008. 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 1.09x the Medicare baseline. Located in 335 Se 8Th Avenue, Hillsboro, OR.

Cash / Self-Pay

$2,180

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,008

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: $1,008 (109%)

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

Ins. Median: $1,008 (109% 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	$393 - $1,190	42%
Intercommunity Health Network	$393 - $786	42%
Medicare (plans)	$393 - $1,190	42%
Kaiser Foundation Hospitals	$403 - $2,954	43%
Pacific Source	$403 - $2,147	43%
Community Health Plan Of Washington	$504 - $3,354	54%
Providence Health Plan	$504 - $3,354	54%
Samaritan Health Plan	$504 - $1,008	54%
Trillium	$504 - $1,008	54%
Humana	$519 - $1,069	56%
UnitedHealthcare	$534 - $3,354	58%
Aetna	$544 - $3,354	59%
Moda	$554 - $3,354	60%
Health Net Health Plan Of Oregon, Inc.	$580 - $2,214	63%
Tuality Health	$907 - $1,815	98%
Blue Cross Blue Shield	$1,336 - $2,673	144%
Cigna	$2,314	250%
First Choice	$2,683	290%
Coventry First Health	$2,851	308%
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 Hillsboro 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.