CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Astria Sunnyside Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,706
Cash Discount Price: $1,892
vs. Medicare Baseline: 1.84x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Astria Sunnyside Hospital is $1,706. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,892. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.84x the Medicare baseline. Located in 1016 Tacoma Avenue, Sunnyside, WA.

Cash / Self-Pay

$1,892

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,706

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: $1,892 (204%)

Insurance Median: $1,706 (184%)

Cash: $1,892 (204% of Medicare)

Ins. Median: $1,706 (184% 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
Medicare (plans)	$157 - $839	17%
Aetna	$814 - $2,922	88%
Healthcomp_Ihs	$814	88%
Humana	$814 - $2,988	88%
Medicaid / KanCare	$814 - $1,018	88%
Molina	$814	88%
Va	$814	88%
Tricare	$822	89%
Regence	$1,706	184%
Cigna	$1,992	215%
Li	$2,038	220%
First_Choice	$2,490	269%
Tpsc	$2,590	280%
Kaiser	$2,607	281%
Premera	$2,702	292%
UnitedHealthcare	$2,822	305%
Fhpw	$2,922	315%
Healthcomp	$2,988	322%
Bcchp	$3,320	358%
Great_Rivers	$3,320	358%
Zenith	$3,320	358%

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 $1,892.
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 Astria Sunnyside 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.