CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Providence Centralia Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,891
Cash Discount Price: $1,631
vs. Medicare Baseline: 2.04x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Providence Centralia Hospital is $1,891. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,631. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.04x the Medicare baseline. Located in 914 S Scheuber Road, Centralia, WA.

Cash / Self-Pay

$1,631

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,891

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: $1,631 (176%)

Insurance Median: $1,891 (204%)

Cash: $1,631 (176% of Medicare)

Ins. Median: $1,891 (204% 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 204% of the Medicare baseline (a markup of 104%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Kaiser	$1,050 - $3,927	113%
Aetna	$1,082 - $9,575	117%
UnitedHealthcare	$1,124	121%
Blue Shield	$1,134 - $6,646	122%
Amerigroup	$1,155	125%
Community Health Plan	$1,680	181%
Molina	$1,775	192%
Blue Cross Blue Shield	$1,890 - $5,533	204%
Coordinated Care	$1,943	210%
First Choice	$4,598	496%

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 $1,631.
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 Providence Centralia 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.