CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Adventist Health Tillamook

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$297

about 0.3× the $927 Medicare rate · typically $128–$1,427

modeled estimate · not a bill or quote

What this hospital charges insurers

$142

Below the fair price — a good deal

about $155 under the fair price · 0.2× Medicare

Medicare pays $927 Fair price $297 This hospital $142 Cash price $355 Hospital's list price $658

How we calculate the fair BaseRate →

How this hospital compares to other OR hospitals

One of the lower prices — 7 of 8 other OR hospitals charge more for the same procedure.

Cheapest $126 Priciest $349

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 $297 (about 0.3× the $927 Medicare rate). Adventist Health Tillamook charges insurers about $142, or about $355 in cash — below the fair price — a good deal. Located in Tillamook, OR.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna CignaHumanaKaiser 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	$256	28%
Blue Cross Blue Shieldmajor	$139 - $572	15%
Aetnamajor	$121 - $266	13%
Devoted Health	$130	14%
Health Net	$618	67%
Moda Health	$123	13%
PacificSource	$330	36%
+ 7 smaller / regional plans	$126 - $644

Government programs also on file: Medicare.

Excludes 1 rental-network / third-party entry (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 355), 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 Adventist Health Tillamook 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 Adventist Health Tillamook

Compare: Upper endoscopy with biopsy at other OR hospitals

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