CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Astria Toppenish Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,040
Cash Discount Price: $1,385
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Astria Toppenish Hospital is $1,040. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,385. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.12x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$1,385

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,040

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: $1,385 (149%)

Insurance Median: $1,040 (112%)

Cash: $1,385 (149% of Medicare)

Ins. Median: $1,040 (112% 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
Medicaid / KanCare	$183 - $3,367	20%
Premera_Affordable_Care	$450 - $1,157	49%
Chpw_Cascade_Care	$752 - $1,933	81%
First_Choice	$824 - $2,117	89%
Li	$860	93%
Ambetter / Centene	$862	93%
UnitedHealthcare	$862 - $2,534	93%
Va	$862 - $1,022	93%
Molina	$879	95%
Medicare (plans)	$888 - $2,534	96%
Aetna	$925 - $2,700	100%
Cigna	$925	100%
Humana	$925 - $3,068	100%
Tricare	$925	100%
Tpsc	$931 - $2,393	100%
Zenith	$934	101%
Regence	$1,040	112%
Molina_Exchange	$1,120	121%
Premera	$1,157	125%
Bcchp	$1,194 - $3,068	129%
Great_Rivers	$1,194 - $3,068	129%
Healthcomp	$1,194 - $3,068	129%
Washington_State_Hca	$1,194 - $3,068	129%
Kaiser	$3,289	355%

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 $1,385.
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 Astria Toppenish 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.