CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Valley Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,053
Cash Discount Price: $4,799
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Valley Medical Center is $1,053. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,799. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.14x the Medicare baseline. Located in 400 S 43Rd St, Renton, WA.

Cash / Self-Pay

$4,799

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,053

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: $4,799 (518%)

Insurance Median: $1,053 (114%)

Cash: $4,799 (518% of Medicare)

Ins. Median: $1,053 (114% 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
Aetna	$68 - $3,213	7%
Humana	$68 - $1,074	7%
Great West [190102]	$289	31%
Christian Brother Employee Benefit Trust [110100]	$344	37%
Pacificsource [130122]	$344	37%
Soundpath Health-Termed [210113]	$839	91%
Blue Cross Blue Shield	$864 - $6,382	93%
Regence Blue Shield [170100]	$864	93%
Regence Uniform [130111]	$864	93%
Chpw Med Advantage [210102]	$1,053	114%
Medicare (plans)	$1,053 - $1,106	114%
Premera Medadvantage [210114]	$1,053	114%
Regence Medadvantage [210111]	$1,053	114%
UnitedHealthcare	$1,053 - $3,525	114%
Wellpoint Medadvantage [210115]	$1,053	114%
Chpw [130116]	$1,685	182%
Molina [130117]	$1,790	193%
Cigna	$2,985	322%
Kaiser Washington Contracted [130118]	$3,744	404%
Kaiser Washington Non Contracted [140116]	$3,744	404%

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 $4,799.
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 Valley Medical Center 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.