CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Providence Little Co of Mary Med Ctr San Pedro

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,694
Cash Discount Price: $508
vs. Medicare Baseline: 2.91x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Providence Little Co of Mary Med Ctr San Pedro is $2,694. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $508. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.91x the Medicare baseline. Located in 1300 W 7Th St, San Pedro, CA.

Cash / Self-Pay

$508

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,694

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: $508 (55%)

Insurance Median: $2,694 (291%)

Cash: $508 (55% of Medicare)

Ins. Median: $2,694 (291% 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 291% of the Medicare baseline (a markup of 191%). 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
Aetna	$1,167	126%
Humana	$1,190	128%
Blue Cross Blue Shield	$1,222 - $3,664	132%
Caremore	$1,283	138%
La Care Health Plan	$1,516	164%
Blue Shield	$1,528 - $4,247	165%
Healthnet	$2,158 - $4,385	233%
UnitedHealthcare	$2,669 - $3,023	288%
Cigna	$6,826 - $14,674	737%

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 $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 Providence Little Co of Mary Med Ctr San Pedro 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.