CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Saint Agnes Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,468
Cash Discount Price: $8,368
vs. Medicare Baseline: 2.66x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Saint Agnes Medical Center is $2,468. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,368. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.66x the Medicare baseline. Located in 1303 E Herndon Ave, Fresno, CA.

Cash / Self-Pay

$8,368

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,468

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: $8,368 (903%)

Insurance Median: $2,468 (266%)

Cash: $8,368 (903% of Medicare)

Ins. Median: $2,468 (266% 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 266% of the Medicare baseline (a markup of 166%). 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	$1,143 - $2,419	123%
Blue Cross Blue Shield	$1,143 - $5,118	123%
Humana	$1,143 - $2,542	123%
UnitedHealthcare	$1,166 - $4,822	126%
Medicare (plans)	$1,191 - $2,542	129%
Welbe Health	$1,200 - $2,540	130%
Blue Shield - Ca	$1,330 - $5,035	144%
Align Senior Care	$1,342 - $2,838	145%
Kaiser Permanente	$2,041 - $4,319	220%
Advantek Central Usd	$2,419 - $5,118	261%
Geha	$4,822	520%
Blue Benefit Administrators Of Massachusetts	$5,035	543%
Blue Care Network	$5,035	543%
Blue Distinction Transplant	$5,035	543%
Blue Shield - Id (Regence)	$5,035	543%
Blue Shield - Ny Highmark Northeastern	$5,035	543%
Blue Shield - Ny Highmark Western	$5,035	543%
Blue Shield - Pa (Highmark)	$5,035	543%
Blue Shield - Wa (Regence)	$5,035	543%

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 $8,368.
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 Saint Agnes Medical Center 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.