CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Samaritan Lebanon Community Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $349
Cash Discount Price: $486
vs. Medicare Baseline: 0.38x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Samaritan Lebanon Community Hospital is $349. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $486. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.38x the Medicare baseline. Located in 525 N Santiam Highway, Lebanon, OR.

Cash / Self-Pay

$486

Average discount available for prompt cash payment at this facility.

Insurance Median

$349

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: $486 (52%)

Insurance Median: $349 (38%)

Cash: $486 (52% of Medicare)

Ins. Median: $349 (38% 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
Providence	$84 - $1,156	9%
Samaritan	$85 - $867	9%
Healthnet	$93 - $835	10%
Regence	$93 - $1,190	10%
Pacificsource	$94 - $851	10%
Devoted Health	$97 - $402	10%
Cigna	$130 - $774	14%
Humana	$130 - $411	14%
Moda	$139 - $1,156	15%
Aetna	$226 - $846	24%
First Choice	$231 - $856	25%
Ihn	$395 - $403	43%

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 $486.
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 Samaritan Lebanon Community Hospital 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.