CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Adventist Health Hanford

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $181
Cash Discount Price: $89
vs. Medicare Baseline: 0.20x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Adventist Health Hanford is $181. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.20x the Medicare baseline. Located in 115 Mall Drive, Hanford, CA.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$181

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: $89 (10%)

Insurance Median: $181 (20%)

Cash: $89 (10% of Medicare)

Ins. Median: $181 (20% 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
Upn Mcal Profee	$117	13%
Blue Shield Mcr Adv	$124	13%
Fhcn Pace Mcr Adv-All Plans	$124	13%
Prime Health Mcr Adv- All Plans	$124	13%
Sante Ipa Mcal/Mcare Hmo Profee Only	$124	13%
Tricare	$124	13%
UnitedHealthcare	$124 - $182	13%
Central Valley Med Prov Profee Only-All Plans	$130	14%
Ah Employee Health Plan - All Plans	$137	15%
Sante Ipa Hmo Profee Only - All Other Plans	$149	16%
Aetna	$154	17%
Cigna	$163	18%
Kaiser - All Other Plans	$168	18%
Kaiser Mcr Adv	$168	18%
Western Growers/Pinnacle- All Plans	$173	19%
Healthnet - All Other Plans	$181	20%
Bc Mcal	$234	25%
Healthnet Mcal	$234	25%
Kaiser Mcal	$234	25%
Medi-Cal	$234	25%
Universal Hc Mcal Profee	$234	25%
Valley Childrens - All Plans	$393	42%
Blue Cross Blue Shield	$427	46%
Blue Shield Epn	$621	67%
Blue Shield Non-Epn - All Other Plans	$656	71%
Universal Hc Mcr Adv Profee - All Other Plans	$1,167	126%
Upn Mcr Adv Profee - All Other Plans	$1,167	126%

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 $89.
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 Hanford 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.