CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Sky Lakes Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,042

about 1.1× the $927 Medicare rate · typically $950–$1,111

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,041

About the fair price

about $1 under the fair price · 1.1× Medicare

Medicare pays $927 Fair price $1,042 This hospital $1,041 Cash price $1,496 Hospital's list price $1,995

How we calculate the fair BaseRate →

How this hospital compares to other OR hospitals

Highest price of the 9 OR hospitals we have prices for — worth calling around.

Cheapest $126 Priciest $1,041

Black dot = this hospital, among the 9 OR hospitals with a price for this procedure. Full list below.

A fair price for a Upper endoscopy with biopsy is about $1,042 (about 1.1× the $927 Medicare rate). Sky Lakes Medical Center charges insurers about $1,041, or about $1,496 in cash — about the fair price. Located in Klamath Falls, OR.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$1,041 - $1,995	112%
Blue Cross Blue Shieldmajor	$1,041 - $1,995	112%
Aetnamajor	$1,041 - $1,995	112%
Cignamajor	$1,041 - $1,995	112%
Humanamajor	$1,041 - $1,995	112%
Kaiser Permanentemajor	$1,041 - $1,995	112%
GEHA	$1,995	215%
Health Net	$1,995	215%
HealthPartners	$1,995	215%
Moda Health	$1,646 - $1,995	178%
MVP Health Care	$1,995	215%
PacificSource	$1,041 - $1,795	112%
Providence Health Plan	$1,995	215%
Sanford Health Plan	$1,995	215%
UPMC Health Plan	$1,995	215%
WellCare	$1,041	112%
+ 200 smaller / regional plans	$1,041 - $1,995

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 19 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 1,496), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Sky Lakes Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Sky Lakes Medical Center

Compare: Upper endoscopy with biopsy at other OR hospitals

Insurance negotiated median for the same procedure, sorted lowest first.