CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Forks Community Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $3,152
Cash Discount Price: $4,497
vs. Medicare Baseline: 3.40x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Forks Community Hospital is $3,152. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,497. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 3.40x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$4,497

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,152

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: $4,497 (485%)

Insurance Median: $3,152 (340%)

Cash: $4,497 (485% of Medicare)

Ins. Median: $3,152 (340% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 340% of the Medicare baseline (a markup of 240%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Medicare (plans)	$318	34%
Medicaid / KanCare	$1,680 - $2,596	181%
Coordinated Care (Mco) Mcd-All Plans	$1,814 - $2,645	196%
UnitedHealthcare	$2,162 - $6,020	233%
Community Health Network Mcr-All Other Plans	$2,186 - $3,187	236%
Humana	$2,186 - $3,187	236%
Tricare	$2,186 - $3,187	236%
Triwest-All Plans	$2,186 - $3,187	236%
Ambetter / Centene	$2,535 - $3,697	274%
Wellcare Med Adv - All Plans	$2,535 - $3,697	274%
Regence-All Other Plans	$2,797 - $4,078	302%
Community Health Exchange	$3,157 - $4,603	341%
Molina Commercial-All Other Plans	$4,468 - $6,515	482%
Blue Cross Blue Shield	$4,614 - $6,728	498%
Aetna	$4,857 - $7,082	524%
Cigna	$4,857 - $7,082	524%
First Choice-All Plans	$4,857 - $7,082	524%

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 $4,497.
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 Forks Community 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.