CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Multicare Covington Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,587
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.71x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Multicare Covington Medical Center is $1,587. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.71x the Medicare baseline. Located in 17700 Se 272Nd St, Covington, WA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,587

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%)

Insurance Median: $1,587 (171%)

Ins. Median: $1,587 (171% 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
Molina	$664 - $1,892	72%
Community Health Plan Of Washington	$717 - $1,724	77%
Coordinated Care	$717	77%
UnitedHealthcare	$717 - $1,064	77%
Wellpoint	$717	77%
Aetna	$1,053 - $4,374	114%
Regence	$1,053	114%
Wellcare	$1,074	116%
Premera	$1,450 - $4,162	156%
Ambetter / Centene	$2,045	221%
First Choice	$2,749 - $4,998	297%
Kaiser	$3,526	381%
Cigna	$7,058	762%

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 $X.
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 Multicare Covington 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.