CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Adventist Health Reedley

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $234
Cash Discount Price: $89
vs. Medicare Baseline: 0.25x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Adventist Health Reedley is $234. 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 0.25x the Medicare baseline. Located in 372 W Cypress Ave, Reedley, CA.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$234

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: $234 (25%)

Cash: $89 (10% of Medicare)

Ins. Median: $234 (25% 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
Kern Health Systems Mcal-All Plans	$50 - $234	5%
Central Ca Alliance Ccs Profee Only	$60	6%
Central Ca Alliance Comm Profee Only - All Other P	$60	6%
Healthnet Medi-Cal	$70	8%
Central Ca Alliance Chdp Profee Only	$80	9%
Blue Shield Mcare	$124 - $1,167	13%
Fhcn Pace Mcr Adv-All Plans	$124 - $1,167	13%
Lasalle Med Assoc Profee Only - All Plans	$124	13%
Sante Ipa Mcal/Mcare Hmo Profee Only	$124	13%
Tricare	$124 - $1,167	13%
UnitedHealthcare	$124 - $8,266	13%
Upn Mcr Adv Profee Only	$124	13%
Ah Employee Health Plan - All Plans	$137 - $2,100	15%
Community Care Ipa Mcal-All Plans	$149 - $304	16%
Sante Ipa Hmo Profee Only - All Other Plans	$149	16%
Aetna	$154 - $10,039	17%
Cigna	$163 - $304	18%
Kaiser - All Other Plans	$168 - $234	18%
Kaiser Mcr Adv	$168 - $1,167	18%
Western Growers/Pinnacle- All Plans	$173 - $10,215	19%
Healthnet- All Other Plans	$181 - $204	20%
Cal Viva Hlth Mcal - All Plans	$234	25%
Medi-Cal	$234	25%
Blue Shield Epn - All Other Plans	$254 - $621	27%
Dignity Mcal Op/Profee Only-All Other Plans	$258	28%
Blue Shield Non Epn	$292 - $656	32%
Physicians Med Group Op/Profee Only- All Plans	$374	40%
Blue Cross Blue Shield	$427 - $8,450	46%
Bc Mcal	$452	49%
Dignity Mcr Adv Op/Profee Only	$1,167	126%
Healthnet- Mcr Adv	$1,167	126%
Phs Prime Health Srvcs	$1,167	126%
Bright Health Mcr Adv - All Plans	$1,831	198%

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 Reedley 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.