CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Arbor Health Morton Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $125
Cash Discount Price: $661
vs. Medicare Baseline: 0.13x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Arbor Health Morton Hospital is $125. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $661. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.13x the Medicare baseline. Located in 521 Adams Street, Morton, WA.

Cash / Self-Pay

$661

Average discount available for prompt cash payment at this facility.

Insurance Median

$125

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: $661 (71%)

Insurance Median: $125 (13%)

Cash: $661 (71% of Medicare)

Ins. Median: $125 (13% 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
Amerigroup-All Other Plans	$79	9%
Comm Health Healthy Options	$79	9%
Kaiser Mcaid	$79	9%
Molina Mcaid	$79	9%
UnitedHealthcare	$79 - $974	9%
Comm Health Basic Sub - All Other Plans	$95	10%
Aetna	$124 - $577	13%
Amerigroup Mcr Adv	$124	13%
Comm Health Mcr Adv	$124	13%
Healthnet Mcr Adv - All Plans	$124	13%
Humana	$124	13%
Mcr Railroad Mcr Adv - All Plans	$124	13%
Medicare (plans)	$124	13%
Premera Hmo Mcr Adv	$124	13%
Rural Health Mcare - All Plans	$124	13%
Regence Blue Shield Mcr Adv	$126	14%
Molina Mcr Adv	$131	14%
Wellcare Mcr Adv - All Plans	$131	14%
Comm Health Pebb	$142	15%
First Choice-All Plans	$190	21%
Kaiser Comm-All Other Plans	$192	21%
Molina Marketplace-All Other Plans	$548 - $731	59%
Regence Blue Shield Ump-All Other Plans	$640 - $853	69%
Premera First-All Other Plans	$823 - $1,096	89%
Cigna	$850 - $1,133	92%

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 $661.
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 Arbor Health Morton 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.