CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Valley Presbyterian Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,412
Cash Discount Price: $1,930
vs. Medicare Baseline: 1.52x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Valley Presbyterian Hospital is $1,412. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,930. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.52x the Medicare baseline. Located in 15107 Vanowen St, Van Nuys, CA.

Cash / Self-Pay

$1,930

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,412

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: $1,930 (208%)

Insurance Median: $1,412 (152%)

Cash: $1,930 (208% of Medicare)

Ins. Median: $1,412 (152% 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 Promise Medi-Cal	$482	52%
La Care Medi-Cal	$1,158	125%
Phcs	$1,158	125%
Blue Shield Senior	$1,167	126%
Aetna	$1,191 - $2,580	129%
Blue Cross Blue Shield	$1,191 - $1,680	129%
Health Net Senior	$1,191	129%
La Care Covered California	$1,191	129%
Medicare (plans)	$1,191 - $1,251	129%
Coventry Health Care (Ccn)	$1,351	146%
UnitedHealthcare	$1,376 - $4,198	148%
Beech Street	$1,448	156%
Ambetter / Centene	$1,680	181%
Multiplan	$1,737	187%
Heritage Provider Network (Regal & Lakeside)	$1,906	206%
Cigna	$2,345	253%
Health Net	$2,355	254%
Blue Shield Ifp	$2,791	301%
Blue Shield	$3,352	362%

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 $1,930.
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 Valley Presbyterian Hospital 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.