CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: St Charles Medical Center Prineville
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $1,634
- Cash Discount Price: $1,502
- vs. Medicare Baseline: 1.76x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at St Charles Medical Center Prineville is $1,634. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,502. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.76x the Medicare baseline. Located in 384 Se Combs Flat Road, Prineville, OR.
Cash / Self-Pay
$1,502
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,634
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: $1,502 (162%)
Insurance Median: $1,634 (176%)
Cash: $1,502 (162% of Medicare)
Ins. Median: $1,634 (176% 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
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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 |
|---|---|---|
| Aetna | $526 - $1,634 | 57% |
| Ageright Advantage [142] | $526 | 57% |
| Champ Va [700] | $526 | 57% |
| Cigna | $526 - $1,183 | 57% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $526 | 57% |
| Devoted Health Inc [145] | $526 | 57% |
| Health Market Care Assured [134] | $526 | 57% |
| Health Net Med Adv [135] | $526 | 57% |
| Humana | $526 | 57% |
| Indian Health [704] | $526 | 57% |
| Kaiser Permanente Med Adv [136] | $526 | 57% |
| Law Enforcement [701] | $526 - $932 | 57% |
| Medicare (plans) | $526 - $610 | 57% |
| Samaritan Health Plan Med Adv [141] | $526 | 57% |
| Unicare [133] | $526 | 57% |
| UnitedHealthcare | $526 - $1,735 | 57% |
| Veterans [706] | $526 | 57% |
| Wellcare [132] | $526 | 57% |
| Tricare | $573 | 62% |
| Blue Cross Blue Shield | $578 - $2,955 | 62% |
| Advanced Health [534] | $657 | 71% |
| Allcare Health Plan [538] | $657 | 71% |
| Cascade Health Alliance [532] | $657 | 71% |
| Columbia Pacific Coordinated Care Llc [539] | $657 | 71% |
| Health Share Care Oregon [526] | $657 | 71% |
| Health Share Kaiser [543] | $657 | 71% |
| Health Share Ohsu Ohp [552] | $657 | 71% |
| Health Share Providence [548] | $657 | 71% |
| Health Share [537] | $657 | 71% |
| Intercommunity Health [530] | $657 | 71% |
| Jackson Care Connect [542] | $657 | 71% |
| Medicaid / KanCare | $657 | 71% |
| Primary Health Of Jospehine County Llc [547] | $657 | 71% |
| Umpqua Health [533] | $657 | 71% |
| Willamette Valley Community Health [536] | $657 | 71% |
| Yamhill County Coordinated Care Org [550] | $657 | 71% |
| Us Benefits [326] | $1,183 | 128% |
| Providence Health Plan [347] | $1,315 - $1,643 | 142% |
| Rocky Mountain Administrators [405] | $1,502 | 162% |
| Rx Internal [4100003] | $1,534 | 166% |
| First Choice Health [317] | $1,626 | 175% |
| Kaiser Permanente [334] | $1,626 | 175% |
| Samaritan [376] | $1,626 | 175% |
| Meritain Health [300] | $1,634 | 176% |
| Health Net [340] | $1,765 | 190% |
| Administrative Concepts Inc [402] | $1,840 | 199% |
| First Health [339] | $1,840 | 199% |
| Manhattan Life Insurance Company [379] | $1,840 | 199% |
| Philadelphia American Life Insurance Company [395] | $1,840 | 199% |
| Planned Administrators Inc [375] | $1,840 | 199% |
| Auto Allstate Insurance [602] | $1,878 | 203% |
| Auto American Family Insurance [603] | $1,878 | 203% |
| Auto Country Insurance Claims [604] | $1,878 | 203% |
| Auto Dairyland Insurance [617] | $1,878 | 203% |
| Auto Farmers [605] | $1,878 | 203% |
| Auto Geico Claims Oregon [606] | $1,878 | 203% |
| Auto Hartford [612] | $1,878 | 203% |
| Auto Liberty Mutual Auto Ins [613] | $1,878 | 203% |
| Auto Mutual Of Enumclaw [610] | $1,878 | 203% |
| Auto Nationwide Allied Insuranc [601] | $1,878 | 203% |
| Auto Oregon Mutual [614] | $1,878 | 203% |
| Auto Progressive [608] | $1,878 | 203% |
| Auto Safeco Concentra [600] | $1,878 | 203% |
| Auto State Farm Claims [609] | $1,878 | 203% |
| Auto Sublimity Insurance [616] | $1,878 | 203% |
| Auto Travelers Insurance [615] | $1,878 | 203% |
| Auto Usaa [611] | $1,878 | 203% |
| Generic Auto [649] | $1,878 | 203% |
| Generic Workers Comp [699] | $1,878 | 203% |
| Otj Broadspire Services [670] | $1,878 | 203% |
| Otj Ccmsi [618] | $1,878 | 203% |
| Otj Chartis Claims [650] | $1,878 | 203% |
| Otj City County Ins Services [662] | $1,878 | 203% |
| Otj Corvel [676] | $1,878 | 203% |
| Otj Esis West Wc Claims [653] | $1,878 | 203% |
| Otj Gallagher Bassett [654] | $1,878 | 203% |
| Otj Hartford [655] | $1,878 | 203% |
| Otj Intermountain Claims Inc [666] | $1,878 | 203% |
| Otj Liberty Mutual Wausau Underwriters [671] | $1,878 | 203% |
| Otj Penser No American [663] | $1,878 | 203% |
| Otj Pinnacle Risk Mgmt [661] | $1,878 | 203% |
| Otj Saif [667] | $1,878 | 203% |
| Otj Sedgwick Cms [660] | $1,878 | 203% |
| Otj Sedgwick [668] | $1,878 | 203% |
| Otj Travelers Insurance [672] | $1,878 | 203% |
| Otj Tristar [673] | $1,878 | 203% |
| Bridgespan [342] | $2,512 | 271% |
| Asuris Northwest Health [202] | $2,955 | 319% |
| Healthcare Management Admin [201] | $2,955 | 319% |
| Regence Group Administrators [203] | $2,955 | 319% |