CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Adventist Health St Helena

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,205
Cash Discount Price: $326
vs. Medicare Baseline: 1.30x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Adventist Health St Helena is $1,205. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $326. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.30x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$326

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,205

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: $326 (35%)

Insurance Median: $1,205 (130%)

Cash: $326 (35% of Medicare)

Ins. Median: $1,205 (130% 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
Blue Shield Bh Mcr Adv	$136 - $1,205	15%
Blue Shield Mcr Adv	$136 - $1,205	15%
Kaiser Mcr Adv	$136 - $1,205	15%
Tricare	$136 - $1,205	15%
Ah Employee Health Plan - All Plans	$149 - $2,169	16%
Interplan-All Plans	$163 - $2,298	18%
Kaiser-All Other Plans	$163 - $3,141	18%
Cigna	$171 - $3,064	18%
UnitedHealthcare	$182 - $2,442	20%
Western Growers-All Plans	$194 - $18,756	21%
Va Medi-Cal	$234	25%
Aetna	$254 - $5,628	27%
Phcs-All Plans	$283 - $2,106	31%
Health Management Network-All Plans	$437 - $3,256	47%
Blue Cross Blue Shield	$451 - $7,424	49%
Three Rivers-All Plans	$463 - $3,447	50%
Blue Shield Epn-All Other Plans	$711 - $10,637	77%
Blue Shield Non-Epn	$752 - $10,891	81%
Va Mcr - All Other Plans	$1,205	130%
Blue Shield Behav Hlth	$1,724	186%
Healthnet-All Plans	$2,348	253%
Choicecare-All Plans	$2,681	289%
Beech Street-All Plans	$2,872	310%
Galaxy Network-All Plans	$3,447	372%

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 $326.
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 Adventist Health St Helena 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.