CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Sharp Coronado Hospital and Hlthcr Ctr

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,452
Cash Discount Price: $3,014
vs. Medicare Baseline: 2.65x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Sharp Coronado Hospital and Hlthcr Ctr is $2,452. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,014. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.65x the Medicare baseline. Located in 250 Prospect Place, Coronado, CA.

Cash / Self-Pay

$3,014

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,452

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: $3,014 (325%)

Insurance Median: $2,452 (265%)

Cash: $3,014 (325% of Medicare)

Ins. Median: $2,452 (265% 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 265% of the Medicare baseline (a markup of 165%). 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
Blue Cross Blue Shield	$254 - $3,014	27%
Epic Americas	$254 - $2,813	27%
Health Net	$563 - $3,014	61%
Aetna	$603 - $3,617	65%
County Medical Services	$1,125 - $2,733	121%
Blue Shield	$1,194 - $3,215	129%
Community Health Group	$1,194 - $3,939	129%
Interplan	$1,194 - $3,014	129%
Humana	$1,226	132%
Molina	$1,366 - $3,617	147%
UnitedHealthcare	$1,366 - $3,939	147%
Kaiser	$1,608 - $2,773	174%
California Health And Wellness	$1,926	208%
Cigna	$2,010 - $3,617	217%
Multiplan	$2,452	265%
Indian Health Council	$2,564 - $2,813	277%
Managed Health Network	$2,636 - $2,693	284%
Medicare (plans)	$2,733 - $3,215	295%
Medi-Cal	$2,813	304%
San Diego Pace	$2,813	304%
Allianz Global Assistance	$3,014	325%

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 $3,014.
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 Sharp Coronado Hospital and Hlthcr Ctr 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.