CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Uc San Diego Health Hillcrest - Hillcrest Med Ctr
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $2,058
- Cash Discount Price: $4,895
- vs. Medicare Baseline: 2.22x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Uc San Diego Health Hillcrest - Hillcrest Med Ctr is $2,058. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,895. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.22x the Medicare baseline. Located in 200 West Arbor Drive, San Diego, CA.
Cash / Self-Pay
$4,895
Average discount available for prompt cash payment at this facility.
Insurance Median
$2,058
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: $4,895 (528%)
Insurance Median: $2,058 (222%)
Cash: $4,895 (528% of Medicare)
Ins. Median: $2,058 (222% 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 222% of the Medicare baseline (a markup of 122%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Alternate Molina [1240] | $44 - $423 | 5% |
| Molina [1055] | $44 - $423 | 5% |
| Community Health Group [1022] | $45 - $433 | 5% |
| Health Net [1039] | $47 - $10,636 | 5% |
| Alameda Alliance For Health [2027] | $336 | 36% |
| Alignment Health Plan [2020] | $336 | 36% |
| Alternate Medi-Cal [2001] | $336 | 36% |
| Blue Cross Blue Shield | $336 - $8,217 | 36% |
| Brand New Day [1089] | $336 | 36% |
| California Department Of Public Health [1237] | $336 | 36% |
| California Health & Wellness Medi-Cal [1122] | $336 | 36% |
| Caremore [2028] | $336 | 36% |
| Cms - County Medical Services [1025] | $336 - $9,109 | 36% |
| Community Care Ipa [1131] | $336 | 36% |
| Community Eldercare [1027] | $336 | 36% |
| Federal Prison [1031] | $336 | 36% |
| Gold Coast Health Plan [2031] | $336 | 36% |
| Health Plan Of San Joaquin [2032] | $336 | 36% |
| Hemet Community Med Grp - Promisecare [1040] | $336 | 36% |
| Imperial Health Holdings [1132] | $336 | 36% |
| Kern Health Systems [2033] | $336 | 36% |
| La Care Health Plan [2025] | $336 | 36% |
| Medi-Cal [1048] | $336 | 36% |
| Medicaid / KanCare | $336 | 36% |
| Regal Mg 'Heritage Provider Network' [2019] | $336 | 36% |
| San Diego County [1071] | $336 - $7,007 | 36% |
| Sd Physicians Med Grp [1076] | $336 - $9,109 | 36% |
| State Of California [1082] | $336 | 36% |
| UnitedHealthcare | $336 - $9,809 | 36% |
| Unlisted Mcal Hmo Non-Contract [1049] | $336 | 36% |
| Vantage [1092] | $336 - $8,408 | 36% |
| Ximed [2016] | $336 | 36% |
| Blue Shield Promise [1017] | $386 | 42% |
| Champva [1020] | $445 | 48% |
| Mid County Physicians Med Grp [1054] | $445 | 48% |
| Aetna | $454 - $7,091 | 49% |
| Cigna | $454 - $8,408 | 49% |
| Humana | $454 - $11,911 | 49% |
| Mc Blue Shield Generic Payor [164016] | $454 - $1,682 | 49% |
| Mc Blue Shield Hmo [164015] | $454 - $1,682 | 49% |
| Mc Brand New Day Generic Payor [164031] | $454 - $1,682 | 49% |
| Mc Brand New Day Hmo [164030] | $454 - $1,682 | 49% |
| Mc Healthnet Generic Payor [164010] | $454 - $1,682 | 49% |
| Mc Healthnet Hmo [164004] | $454 - $1,682 | 49% |
| Mc Hnet Blue&Gold Aco [164017] | $454 - $1,682 | 49% |
| Mc Scan Generic Payor [164034] | $454 - $1,682 | 49% |
| Mc Scan Hmo [164035] | $454 - $1,682 | 49% |
| Uc Aff Blue Shield Sr/Sdsm [164037] | $454 - $1,682 | 49% |
| Inland Empire Health Plan Transplant [1126] | $470 | 51% |
| Inland Empire Health Plan [1121] | $470 | 51% |
| Cal Optima [1016] | $487 | 53% |
| Padres Workers Compensation [2013] | $609 - $2,256 | 66% |
| Padres [2014] | $609 - $2,256 | 66% |
| Ucr Prompt Pay Payor [8240] | $762 | 82% |
| Alternate Scan Health [2088] | $1,191 - $1,514 | 129% |
| Scan Health [1072] | $1,191 - $1,514 | 129% |
| Alternate Healthnet [1007] | $1,313 - $6,796 | 142% |
| Multicultural Med Grp [1057] | $1,374 - $5,087 | 148% |
| Elizabeth Hospice [2018] | $1,514 - $5,605 | 163% |
| Scripps Clinic [1073] | $1,514 - $8,408 | 163% |
| Blue Shield [1014] | $1,606 - $11,865 | 173% |
| Alternate Health Net Bh [2059] | $1,836 - $6,796 | 198% |
| Healthnet Transplants [1114] | $1,836 - $6,796 | 198% |
| Usoc - Us Olympic Committee [1123] | $1,870 - $6,923 | 202% |
| Global Excel [1036] | $1,892 - $7,007 | 204% |
| Sharp Health Plan [1079] | $1,892 - $7,077 | 204% |
| Graybill Med Grp [1037] | $1,911 - $7,077 | 206% |
| Sharp Community Med Grp [1078] | $1,911 - $7,077 | 206% |
| Sharp Rees Stealy [1080] | $1,911 - $7,077 | 206% |
| Olympus Managed Healthcare Inc [1102] | $1,915 - $7,091 | 207% |
| Scripps Health Plan Services [1075] | $2,271 - $8,408 | 245% |
| Alternate Sheriff Custody [1106] | $2,460 - $9,109 | 265% |
| Arch Health Partners [2000] | $2,460 - $9,109 | 265% |
| Axa Assistance [1098] | $2,460 - $9,109 | 265% |
| Cassidy Med Grp [1019] | $2,460 - $9,109 | 265% |
| Cmn - Canadian Medical Network [1024] | $2,460 - $9,109 | 265% |
| Ets - Lifetrac Network [1103] | $2,460 - $9,109 | 265% |
| Health Net Bh (Mhn) [1038] | $2,460 - $9,109 | 265% |
| Health Net Bh (Mhn) [2010] | $2,460 - $9,109 | 265% |
| Interlink Health Services Transplant [1124] | $2,460 - $9,109 | 265% |
| Interlink Health Transplant [2085] | $2,460 - $9,109 | 265% |
| Mgm Resorts [1053] | $2,460 - $9,109 | 265% |
| National Healthcare Solutions Inc [1100] | $2,460 - $9,109 | 265% |
| Quality Health [1069] | $2,460 - $9,109 | 265% |
| San Diego County Sheriff Custody [2012] | $2,460 - $9,109 | 265% |
| Scripps Coastal Med Grp [1074] | $2,460 - $9,109 | 265% |
| Tri-City [1085] | $2,460 - $9,109 | 265% |
| Kaiser [1046] | $2,536 - $9,389 | 274% |
| Embassy Sponsored [1101] | $2,574 - $9,809 | 278% |
| Interplan [1045] | $2,650 - $9,809 | 286% |
| Mercy Physicians Med Grp [1052] | $2,650 - $9,809 | 286% |
| Pacific Foundation [1063] | $2,650 - $9,809 | 286% |
| Beech Street [1012] | $2,839 - $10,510 | 306% |
| First Health [1032] | $2,839 - $10,510 | 306% |
| Admar [1001] | $2,914 - $10,790 | 314% |
| Bps - Benefit Plan Services [1015] | $2,914 - $10,790 | 314% |
| Multiplan [1058] | $2,914 - $10,790 | 314% |
| Private Healthcare Systems [1067] | $2,914 - $14,013 | 314% |
| Carnival Cruises [1018] | $3,028 - $11,211 | 327% |
| Alternate Kaiser Rad Onc [2089] | $3,785 - $14,013 | 408% |
| Chargers Football Company [1109] | $3,785 | 408% |
| Palomar Health [1128] | $4,542 | 490% |
| Easy Choice [1029] | $4,731 | 511% |
| Sharp Healthcare Transplant [1119] | $5,110 - $18,918 | 551% |
| Alternate Blue Shield [2002] | $10,382 - $11,865 | 1120% |
| Blue Shield Transplants [1113] | $10,382 - $11,865 | 1120% |