CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Lake Chelan Community Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,223
Cash Discount Price: $2,508
vs. Medicare Baseline: 2.40x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Lake Chelan Community Hospital is $2,223. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,508. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.40x the Medicare baseline. Located in 110 S Apple Blossom Dr, Chelan, WA.

Cash / Self-Pay

$2,508

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,223

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: $2,508 (271%)

Insurance Median: $2,223 (240%)

Cash: $2,508 (271% of Medicare)

Ins. Median: $2,223 (240% 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 240% of the Medicare baseline (a markup of 140%). 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
Coordinated Care Mcaid	$79 - $2,361	9%
Medicare (plans)	$124 - $2,223	13%
Molina - All Plans	$124 - $3,734	13%
UnitedHealthcare	$124 - $3,759	13%
Coordinated Care Comm - All Other Plans	$162 - $3,967	17%
Premera First - All Plans	$183 - $3,031	20%
First Choice - All Plans	$192 - $3,839	21%
Amerigroup Op Only - All Plans	$220 - $2,361	24%
Aetna	$877 - $3,637	95%
Corvel - All Plans	$926 - $3,839	100%
Multiplan - All Plans	$3,597	388%

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 $2,508.
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 Lake Chelan 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.