CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Seattle Children's Hospital
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $1,750
- Cash Discount Price: $13,747
- vs. Medicare Baseline: 1.89x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Seattle Children's Hospital is $1,750. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $13,747. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.89x the Medicare baseline. Located in 4800 Sand Point Way Ne, Po Box C-5371, Seattle, WA.
Cash / Self-Pay
$13,747
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,750
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: $13,747 (1484%)
Insurance Median: $1,750 (189%)
Cash: $13,747 (1484% of Medicare)
Ins. Median: $1,750 (189% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Child Hearing League [17301] | $79 - $1,356 | 9% |
| Hospice [17306] | $79 - $1,356 | 9% |
| Maple Lane School [17309] | $79 - $1,356 | 9% |
| Medicaid / KanCare | $79 - $1,356 | 9% |
| Chpw [15802] | $81 - $1,397 | 9% |
| Coordinated Care [15815] | $83 - $1,424 | 9% |
| Icw Wellpoint [15822] | $83 - $1,424 | 9% |
| Kaiser [15818] | $83 - $1,383 | 9% |
| Molina [15809] | $83 - $1,383 | 9% |
| Opticare [15895] | $83 - $1,424 | 9% |
| Wellpoint [15814] | $83 - $1,424 | 9% |
| Ubh Community & State [15819] | $87 - $1,750 | 9% |
| UnitedHealthcare | $87 - $4,575 | 9% |
| Eye Quest [15894] | $91 - $1,424 | 10% |
| Usfhp [12208] | $166 - $2,207 | 18% |
| Coordinated Care [12267] | $215 - $4,037 | 23% |
| Molina Marketplace [12831] | $224 - $4,037 | 24% |
| Chpw Cascade [12228] | $231 - $2,960 | 25% |
| Regence Ump [12263] | $276 - $3,499 | 30% |
| Pb Premera [11601] | $308 | 33% |
| Premera [11600] | $308 - $4,467 | 33% |
| Administrators [13102] | $319 - $4,575 | 34% |
| Allied [13129] | $319 - $4,575 | 34% |
| Assurant Health Fc [13135] | $319 - $4,575 | 34% |
| Coastal Administrative [13140] | $319 - $4,575 | 34% |
| Ebms Fc [13144] | $319 - $4,575 | 34% |
| First Choice [13399] | $319 - $4,575 | 34% |
| Health Alliance [13233] | $319 - $4,575 | 34% |
| Ilwu-Pma [13158] | $319 - $4,575 | 34% |
| Loomis Benefits West [13161] | $319 - $4,575 | 34% |
| Meritain Health [13229] | $319 - $4,575 | 34% |
| Moda Fc [13219] | $319 - $4,575 | 34% |
| Myers Stevens & Toohey [13169] | $319 - $4,575 | 34% |
| Pacific Underwriters [13175] | $319 - $4,575 | 34% |
| Personify Fc [13155] | $319 - $4,575 | 34% |
| Providence Health Plan [13181] | $319 - $4,575 | 34% |
| Rehn & Associates [13182] | $319 - $4,575 | 34% |
| Samaritan Health [12265] | $319 | 34% |
| Starmark [13103] | $319 - $4,575 | 34% |
| Tongass Timber Trust [13202] | $319 - $4,575 | 34% |
| Trusteed Plans [13186] | $319 - $4,575 | 34% |
| Trustmark Life Insurance [13203] | $319 - $4,575 | 34% |
| Welfare Pension [13120] | $319 - $4,575 | 34% |
| Wship [13121] | $319 - $4,575 | 34% |
| Zenith American Solutions [13195] | $319 - $4,575 | 34% |
| Asuris [11900] | $322 - $4,467 | 35% |
| Asuris [11913] | $322 - $2,906 | 35% |
| Bridgespan Health Company [11906] | $322 - $2,906 | 35% |
| Pb Regence [11908] | $322 | 35% |
| Regence [11903] | $322 - $4,467 | 35% |
| Regence [11909] | $322 - $2,906 | 35% |
| Kaiser [13400] | $326 - $4,037 | 35% |
| Kaiser [13401] | $326 - $3,499 | 35% |
| Allegiance [12264] | $332 - $4,575 | 36% |
| Cigna | $332 - $4,575 | 36% |
| Personify [12270] | $332 - $4,575 | 36% |
| Providence Health Plan [12289] | $332 - $4,575 | 36% |
| Tufts Health Plan [12279] | $332 - $4,575 | 36% |
| Aetna | $357 - $4,521 | 39% |
| Ameriben [11006] | $357 - $4,521 | 39% |
| Christian Brothers [11001] | $357 - $4,521 | 39% |
| Coresource [11004] | $357 - $4,521 | 39% |
| Ebms [11003] | $357 - $4,521 | 39% |
| Meritain [12251] | $357 - $5,113 | 39% |
| Moda [11009] | $357 - $4,521 | 39% |
| Preferred One [11008] | $357 - $4,521 | 39% |
| Web Tpa [11007] | $357 - $4,521 | 39% |
| Claritev [12299] | $456 - $5,113 | 49% |
| Ebms [12241] | $456 - $5,113 | 49% |
| Health Alliance [12266] | $456 - $5,113 | 49% |
| Humana | $456 - $5,113 | 49% |
| Key Benefit Admin [12276] | $456 - $5,113 | 49% |
| Medical Mutual [12233] | $456 - $5,113 | 49% |
| Moda [12842] | $456 - $5,113 | 49% |
| Nippon Life Insurance [12232] | $456 - $5,113 | 49% |
| Pehp [12235] | $456 - $5,113 | 49% |
| Preferredone Admin Services [12236] | $456 - $5,113 | 49% |
| Select Health [12277] | $456 - $5,113 | 49% |
| Blue Cross Blue Shield | $4,467 | 482% |
| Carpenters Trust [13100] | $4,575 | 494% |
| Coventry Fc [13112] | $4,575 | 494% |
| Guardian Fc [13105] | $4,575 | 494% |
| Kps [13109] | $4,575 | 494% |
| Mega Life [13111] | $4,575 | 494% |
| Principal Mutual Fc [13115] | $4,575 | 494% |
| Psew [13124] | $4,575 | 494% |
| Sound Health And Wellness [13116] | $4,575 | 494% |
| Zenith [13123] | $4,575 | 494% |
| United Behavioral Health [12234] | $4,737 | 511% |
| Coastal Admin Svcs Contracted [12222] | $4,844 | 523% |
| Personify Contracted [12205] | $4,844 | 523% |
| Altius Health Plan [12275] | $5,167 | 558% |
| Coventry Mhbp [12272] | $5,167 | 558% |
| Coventry [12244] | $5,167 | 558% |
| First Health [12210] | $5,167 | 558% |
| Hcc Medical [12274] | $5,167 | 558% |
| Lewermark [12286] | $5,167 | 558% |
| Medishare [12287] | $5,167 | 558% |
| Pacificsource [12245] | $5,167 | 558% |
| Rural Carrier Benefit Plan [12271] | $5,167 | 558% |