CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Cascade Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $729
Cash Discount Price: $1,344
vs. Medicare Baseline: 0.79x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Cascade Medical Center is $729. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,344. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.79x the Medicare baseline. Located in 817 Commercial Street, Leavenworth, WA.

Cash / Self-Pay

$1,344

Average discount available for prompt cash payment at this facility.

Insurance Median

$729

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: $1,344 (145%)

Insurance Median: $729 (79%)

Cash: $1,344 (145% of Medicare)

Ins. Median: $729 (79% 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	$140 - $2,296	15%
Asuris Northwest Health	$140 - $2,296	15%
Blue Cross Blue Shield	$140 - $1,939	15%
Humana	$140 - $1,475	15%
Medicare (plans)	$140 - $1,475	15%
Molina Healthcare Of Washington Mcr Adv	$142 - $1,490	15%
Wellcare Health Plan Inc Mcr Adv	$151 - $1,593	16%
Tricare	$386	42%
Medicaid / KanCare	$433 - $1,363	47%
Community Health Plan Of Wa Mcd Rep	$451 - $1,419	49%
Coordinated Care Of Wa Mcd Rep	$451 - $1,419	49%
Molina Healthcare Of Washington Mcd Rep	$451 - $1,419	49%
First Choice Health Network	$484	52%
Pacificsource Health Plans	$484	52%
Ambetter / Centene	$508 - $1,599	55%
Community Health Plan Of Wa	$526 - $1,658	57%
Cigna	$677 - $2,133	73%
Washington Department Of Labor And Industry	$723 - $2,275	78%

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 $1,344.
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 Cascade 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.