CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Island Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $333
Cash Discount Price: $341
vs. Medicare Baseline: 0.36x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Island Hospital is $333. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $341. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.36x the Medicare baseline. Located in 1211 24Th Street, Anacortes, WA.

Cash / Self-Pay

$341

Average discount available for prompt cash payment at this facility.

Insurance Median

$333

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: $341 (37%)

Insurance Median: $333 (36%)

Cash: $341 (37% of Medicare)

Ins. Median: $333 (36% 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
UnitedHealthcare	$168 - $348	18%
Premera Comm - All Other Plans	$182	20%
Kaiser Comm - All Other Plans	$186 - $195	20%
First Choice - All Plans	$190	21%
Multiplan - All Plans	$198	21%
Regence Comm - All Other Plans	$203	22%
Cigna	$266 - $278	29%
First Health - All Plans	$283 - $296	31%
Aarp Mcr Adv - All Plans	$333 - $348	36%
Chpw Mcaid - All Plans	$333 - $348	36%
Coordinated Care Mcaid - All Plans	$333 - $348	36%
Humana	$333 - $348	36%
Kaiser Mcr Adv	$333 - $348	36%
Molina Mcaid - All Plans	$333 - $348	36%
Samish Indian Health - All Plans	$333 - $348	36%
Swinomish Indian Health - All Plans	$333 - $348	36%
Tricare	$333 - $348	36%
Aetna	$350 - $577	38%
Premera Mcr Adv	$350 - $365	38%
Amerigroup Mcaid - All Plans	$353 - $369	38%
Regence Mcr Adv	$353 - $369	38%

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 $341.
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 Island 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.