CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Sky Lakes Medical Center
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $1,995
- Cash Discount Price: $1,496
- vs. Medicare Baseline: 2.15x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Sky Lakes Medical Center is $1,995. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,496. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.15x the Medicare baseline. Located in 2865 Daggett Avenue, Klamath Falls, OR.
Cash / Self-Pay
$1,496
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,995
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: $1,496 (161%)
Insurance Median: $1,995 (215%)
Cash: $1,496 (161% of Medicare)
Ins. Median: $1,995 (215% 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 215% of the Medicare baseline (a markup of 115%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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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 |
|---|---|---|
| Pyramid Todays Option Premier [7015] | $1,041 | 112% |
| Kaiser Med Adv Oregon HMO [7009] | $1,041 | 112% |
| Humana | $1,041 - $1,995 | 112% |
| Pacificsource Med Adv HMO [7035] | $1,041 | 112% |
| Blue Cross Blue Shield | $1,041 - $1,995 | 112% |
| Wellcare Healthnet Med Adv HMO [7022] | $1,041 | 112% |
| Managed Hlth Netwrk Bh Wellcare [7042] | $1,041 | 112% |
| Allcare Advantage [7006] | $1,041 | 112% |
| Kaiser Med Adv So California HMO [7038] | $1,041 | 112% |
| Kaiser Med Adv No California HMO [7037] | $1,041 | 112% |
| Cigna | $1,041 - $1,995 | 112% |
| UnitedHealthcare | $1,041 - $1,995 | 112% |
| Wellcare Healthnet Med Adv PPO [7023] | $1,041 | 112% |
| Alignment Health Plan [7029] | $1,041 | 112% |
| Aetna | $1,041 - $1,995 | 112% |
| Kaiser Med Adv HMO [7027] | $1,041 | 112% |
| Regence Medadvantage [7017] | $1,041 | 112% |
| Samaritan Health Med Adv HMO [7043] | $1,041 | 112% |
| Kaiser Med Adv Senior Nw [7028] | $1,041 | 112% |
| Medicare (plans) | $1,041 - $1,995 | 112% |
| Scan Health Plan [7024] | $1,041 | 112% |
| Pacificsource Med Adv PPO [7018] | $1,041 | 112% |
| Moda Health [1070] | $1,646 - $1,995 | 178% |
| Pacificsource Health Plan PPO [1072] | $1,795 | 194% |
| Pacificsource [1195] | $1,795 | 194% |
| Ufcw [1095] | $1,995 | 215% |
| First Choice Health PPO [1220] | $1,995 | 215% |
| The General [3055] | $1,995 | 215% |
| Zurich Farmers [6029] | $1,995 | 215% |
| Kaiser Permanente Hawaii [3050] | $1,995 | 215% |
| Matrix Absence Management Inc [6038] | $1,995 | 215% |
| Kaiser Permanente [1056] | $1,995 | 215% |
| Aig Workers Compensation [6000] | $1,995 | 215% |
| Ohp Doctors of Oregon Coast So [5007] | $1,995 | 215% |
| Sbma [1252] | $1,995 | 215% |
| Bakery and Confectionery Union [1119] | $1,995 | 215% |
| UPMC Health Plan [1228] | $1,995 | 215% |
| Safeco [6021] | $1,995 | 215% |
| Kaiser Permanente [3047] | $1,995 | 215% |
| Joint Labor Mgmt Retail Trust [1055] | $1,995 | 215% |
| Meritain Health [1129] | $1,995 | 215% |
| Tribal Health Coquille [1088] | $1,995 | 215% |
| Masters Mates and Pilots [1063] | $1,995 | 215% |
| University of Utah Health Plans [1212] | $1,995 | 215% |
| Kaiser of Washington [1207] | $1,995 | 215% |
| Veterans Administration [4004] | $1,995 | 215% |
| Coordinated Benefit Plans [1124] | $1,995 | 215% |
| Plumbing and Pipefitting Trst [1076] | $1,995 | 215% |
| Geha [1038] | $1,995 | 215% |
| S&S Health Tpa PPO [1219] | $1,995 | 215% |
| Us Department of Labor [6036] | $1,995 | 215% |
| Us Department of Labor [6011] | $1,995 | 215% |
| Asante Hospice [1048] | $1,995 | 215% |
| Contra Costa Health [5038] | $1,995 | 215% |
| Gravie Administrative Services [1249] | $1,995 | 215% |
| Healthnet Med Supp [1149] | $1,995 | 215% |
| Cco Advanced Health [5027] | $1,995 | 215% |
| United Teacher Assoc Ins Co [1171] | $1,995 | 215% |
| Special District Assoc of Or [6024] | $1,995 | 215% |
| Cco Eastern Oregon [5023] | $1,995 | 215% |
| Oregon Mutual Insurance Co [6019] | $1,995 | 215% |
| Sentinel Security Life Insurance [1189] | $1,995 | 215% |
| Ohp Marion Polk Comm Health Pl [5012] | $1,995 | 215% |
| Teamsters Food Employers Med Supp [1239] | $1,995 | 215% |
| Auic Org [1118] | $1,995 | 215% |
| Managed Hlth Netwrk Bh Healthnet [1233] | $1,995 | 215% |
| Cco Pacifisource Community Sol [5016] | $1,995 | 215% |
| Providence Hospice [1050] | $1,995 | 215% |
| Tribal Health Klamath [1091] | $1,995 | 215% |
| Tcc of South Carolina [1135] | $1,995 | 215% |
| Travelers Insurance Oregon Mva [6050] | $1,995 | 215% |
| Principal Life Insurance [1077] | $1,995 | 215% |
| Us Marshals Office [8005] | $1,995 | 215% |
| Claims Administrator Lucent Health [1188] | $1,995 | 215% |
| Geico [6032] | $1,995 | 215% |
| Zurich North America - Claims [6058] | $1,995 | 215% |
| Specialty Risk Solutions [6025] | $1,995 | 215% |
| National General Accident Health [1202] | $1,995 | 215% |
| Bs of Ca Promise Health Plan [5039] | $1,995 | 215% |
| Shasta Administrators [1092] | $1,995 | 215% |
| Careassist Program/Tpa [1165] | $1,995 | 215% |
| Nationwide Worker's Comp [3032] | $1,995 | 215% |
| Aither Health Plan [1243] | $1,995 | 215% |
| Bridgespan Health [1213] | $1,995 | 215% |
| Deseret Mutual Mhn [1030] | $1,995 | 215% |
| Travelers Insurance Oregon Wc [6035] | $1,995 | 215% |
| Western Growers Assurance Trust [3053] | $1,995 | 215% |
| Partnership Healthplan of Ca [5033] | $1,995 | 215% |
| Liberty Mutual [6049] | $1,995 | 215% |
| Standard Life [1169] | $1,995 | 215% |
| Cannon Cochran Mgmt [6005] | $1,995 | 215% |
| Cco Health Share OHSU [5041] | $1,995 | 215% |
| Mutual of Omaha [1068] | $1,995 | 215% |
| Lineco Ins First Health [1059] | $1,995 | 215% |
| City County Ins Service [6007] | $1,995 | 215% |
| Office Workers Com [6018] | $1,995 | 215% |
| Connecticut General Life [1122] | $1,995 | 215% |
| Broadspire [6034] | $1,995 | 215% |
| Asuris Northwest Health [1117] | $1,995 | 215% |
| Gpa [1193] | $1,995 | 215% |
| United American Ins [1097] | $1,995 | 215% |
| Western Benefits [1101] | $1,995 | 215% |
| Eob Tpa LLC [1250] | $1,995 | 215% |
| Arkansas Walmart Claims Mgmt [6003] | $1,995 | 215% |
| Mediplus Troa Claims [1064] | $1,995 | 215% |
| Argo Group Us Wc Claims [6002] | $1,995 | 215% |
| Avma Health Group 1St Hlth PPO [1016] | $1,995 | 215% |
| Aflac Med Supp [1234] | $1,995 | 215% |
| Providence Health Ph & S Oregon [3036] | $1,995 | 215% |
| Zenith Admin [1104] | $1,995 | 215% |
| State of Oregon [5019] | $1,995 | 215% |
| Nationwide Ins [3051] | $1,995 | 215% |
| Phillips Admin Service [1073] | $1,995 | 215% |
| Bristol Hospice [1206] | $1,995 | 215% |
| Ebms [1031] | $1,995 | 215% |
| Uct Insurance [1094] | $1,995 | 215% |
| Construction Teamsters [1123] | $1,995 | 215% |
| Lumico Life Insurance [1183] | $1,995 | 215% |
| Ilwu Pma Welfare Plan [1053] | $1,995 | 215% |
| Tantara [1110] | $1,995 | 215% |
| Met Life Mva [3045] | $1,995 | 215% |
| Verdegard Administrators LLC [1204] | $1,995 | 215% |
| Medi Cal [5002] | $1,995 | 215% |
| Continental Benefits [1196] | $1,995 | 215% |
| Liberty Health Plan [1057] | $1,995 | 215% |
| Woodmen Life Supplement [1248] | $1,995 | 215% |
| Lifewise Tpm Trust [1058] | $1,995 | 215% |
| Mailhandlers Benefit [1062] | $1,995 | 215% |
| Standard Life and Accident Ins [1167] | $1,995 | 215% |
| Health Now Admin Services [1120] | $1,995 | 215% |
| Greater Oregon Behavioral Hlth [5001] | $1,995 | 215% |
| Samaritan Health Plan [3043] | $1,995 | 215% |
| Blue Shield Covered California [1241] | $1,995 | 215% |
| Teamsters Benefit Trust [1190] | $1,995 | 215% |
| Allcare Medigap [1162] | $1,995 | 215% |
| Mvp Select Care [1140] | $1,995 | 215% |
| Operating Engineers [1071] | $1,995 | 215% |
| Loomis [1060] | $1,995 | 215% |
| Pemco Mutual Insurance [6044] | $1,995 | 215% |
| Transamerica Gap Supplement [1186] | $1,995 | 215% |
| Champva [4001] | $1,995 | 215% |
| Usaa Auto Insurance [3048] | $1,995 | 215% |
| Physicians Mutual Ins [1074] | $1,995 | 215% |
| Farmers Ins Medical [1033] | $1,995 | 215% |
| Kaiser Northern California HMO [1223] | $1,995 | 215% |
| Managed Care Administrators [1128] | $1,995 | 215% |
| Cco Health Share Tuality [5028] | $1,995 | 215% |
| Pyramid Life Insurance [1080] | $1,995 | 215% |
| Gallagher Bassett [6013] | $1,995 | 215% |
| Cypress Benefit Administrators [1179] | $1,995 | 215% |
| Oregon State Police [8004] | $1,995 | 215% |
| Screenwise Program [5017] | $1,995 | 215% |
| North America Administrators [1174] | $1,995 | 215% |
| Harrington Benefit Services [1043] | $1,995 | 215% |
| American National [1178] | $1,995 | 215% |
| Pioneer Life [1075] | $1,995 | 215% |
| Cambridge Integrated Service [6004] | $1,995 | 215% |
| Progressive Auto [6020] | $1,995 | 215% |
| Wells Fargo Insurance Services [1139] | $1,995 | 215% |
| Wausau Ins [1100] | $1,995 | 215% |
| Albertson [1004] | $1,995 | 215% |
| Hartford [6015] | $1,995 | 215% |
| Country Companies [6008] | $1,995 | 215% |
| Plexis Healthcare Systems [1246] | $1,995 | 215% |
| Washington Dept of Labor & Ind [6051] | $1,995 | 215% |
| Amshield [6057] | $1,995 | 215% |
| Triwest [4006] | $1,995 | 215% |
| Nonstop Wellness [3044] | $1,995 | 215% |
| Motion Picture Health [1066] | $1,995 | 215% |
| Iec Benefit Administrators [1052] | $1,995 | 215% |
| Rsl Specialty Products Admin [1131] | $1,995 | 215% |
| Thrivent Financial [1176] | $1,995 | 215% |
| Ohp Newborn Pending Id [8006] | $1,995 | 215% |
| Trustmark [1209] | $1,995 | 215% |
| Enumclaw Property & Casualty [6045] | $1,995 | 215% |
| Us Family Health Plan [4007] | $1,995 | 215% |
| Healthpartners [1192] | $1,995 | 215% |
| Veterans Evaluation Services [4008] | $1,995 | 215% |
| Options for Southern Oregon [5022] | $1,995 | 215% |
| Personify Health [1125] | $1,995 | 215% |
| Medicaid / KanCare | $1,995 | 215% |
| Cna Workers Compensation [6056] | $1,995 | 215% |
| Sedgwick Cms [6023] | $1,995 | 215% |
| Cco Allcare Health Plan [5013] | $1,995 | 215% |
| Mba Benefit Administrators [1253] | $1,995 | 215% |
| Josephine County [6030] | $1,995 | 215% |
| Claimsbridge Ath01 [1254] | $1,995 | 215% |
| Tribal Health Karuk [1090] | $1,995 | 215% |
| Sierra Health and Life [1200] | $1,995 | 215% |
| Samba [1082] | $1,995 | 215% |
| Plumbers and Pipefitters Union [1083] | $1,995 | 215% |
| So Ca Drug Benefit Fund [1133] | $1,995 | 215% |
| Mega Life and Hlth [1065] | $1,995 | 215% |
| Intermountain Claims [6014] | $1,995 | 215% |
| Mba Merchants Benefit Admin [1247] | $1,995 | 215% |
| Alaska Teamster [1116] | $1,995 | 215% |
| Starr Indemnity and Liability [1134] | $1,995 | 215% |
| Kaiser Covered California [5035] | $1,995 | 215% |
| Lucent Health [1187] | $1,995 | 215% |
| Hartford Auto Insurance [3049] | $1,995 | 215% |
| Cas Tpa [1210] | $1,995 | 215% |
| Western Teamsters Welfare [1103] | $1,995 | 215% |
| Cco Intercommunity Health Network [5010] | $1,995 | 215% |
| Providence Health Plan Bh [1205] | $1,995 | 215% |
| Crime Victims Comp Program [8002] | $1,995 | 215% |
| State Mutual Insurance Company [1173] | $1,995 | 215% |
| Cco Health Share Kaiser [5031] | $1,995 | 215% |
| Liberty Mutual [6016] | $1,995 | 215% |
| Healthcare Management Admin [1109] | $1,995 | 215% |
| Select Health Plan PPO [1132] | $1,995 | 215% |
| G and G Electric Healthcare Plan [1036] | $1,995 | 215% |
| Healthscope [1126] | $1,995 | 215% |
| Globe Life and Accident Ins Co [1177] | $1,995 | 215% |
| Alaska Electrical [1003] | $1,995 | 215% |
| Ameriben Solutions [1007] | $1,995 | 215% |
| Allstate Mva [6001] | $1,995 | 215% |
| Allied Benefit Systems [1158] | $1,995 | 215% |
| Central States Idemnity Med Supp [1143] | $1,995 | 215% |
| Web Tpa [1170] | $1,995 | 215% |
| Combined Insurance [1106] | $1,995 | 215% |
| Imagine 360 [1251] | $1,995 | 215% |
| Cco Trillium Community Health Plan [5011] | $1,995 | 215% |
| Washington National Ins [1099] | $1,995 | 215% |
| Cco Jackson Care Connect [5005] | $1,995 | 215% |
| Asante Moda Health Plan [1245] | $1,995 | 215% |
| Jackson County [8003] | $1,995 | 215% |
| Boilermaker Natl Hlth and Wlfr [1020] | $1,995 | 215% |
| Healthnet PPO [1047] | $1,995 | 215% |
| Kemper Auto [3062] | $1,995 | 215% |
| Tricare | $1,995 | 215% |
| State Farm Health [1084] | $1,995 | 215% |
| Teamsters Food Employers Sec [1136] | $1,995 | 215% |
| Cco Columbia Pacific [5026] | $1,995 | 215% |
| State Comp of Ca [6026] | $1,995 | 215% |
| Blue Shield Out of State PPO [1235] | $1,995 | 215% |
| Union Pacific Rr Emp Health [1096] | $1,995 | 215% |
| United Indian Health Services [1211] | $1,995 | 215% |
| Cco Yamhill Community Care Org [5032] | $1,995 | 215% |
| Medico Insurance Company [1194] | $1,995 | 215% |
| Root Insurance Company [6048] | $1,995 | 215% |
| Providence Health Assur Med Supp [1079] | $1,995 | 215% |
| Iac [1157] | $1,995 | 215% |
| Cco Health Share Oregon [5030] | $1,995 | 215% |
| Usaa Ins [1098] | $1,995 | 215% |
| Pai [1130] | $1,995 | 215% |
| American Family Auto [3033] | $1,995 | 215% |
| Chartis [6006] | $1,995 | 215% |
| Sky Lakes Health Plan [1156] | $1,995 | 215% |
| Fra Ins Plans [1035] | $1,995 | 215% |
| Cco Umpqua Health Alliance [5008] | $1,995 | 215% |
| Saif [6022] | $1,995 | 215% |
| Esis [6047] | $1,995 | 215% |
| Tristar Insurance Group [6042] | $1,995 | 215% |
| Delta Health System [1107] | $1,995 | 215% |
| Crawford and Co [6009] | $1,995 | 215% |
| International Benefit Administrator [1172] | $1,995 | 215% |
| Sanford Health Plan [1147] | $1,995 | 215% |
| Equitable [1032] | $1,995 | 215% |
| Covered California [5040] | $1,995 | 215% |
| Transamerica Life Ins [1087] | $1,995 | 215% |
| State Farm [6027] | $1,995 | 215% |
| Dairyland Auto Ins [6010] | $1,995 | 215% |
| National Guardian Life [1208] | $1,995 | 215% |
| Farmers Insurance [6012] | $1,995 | 215% |
| Corvel [3066] | $1,995 | 215% |
| Ag Specialty Insurance [1242] | $1,995 | 215% |
| Sublimity Insurance [6028] | $1,995 | 215% |