CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Arrowhead Regional Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,167
Cash Discount Price: $4,576
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Arrowhead Regional Medical Center is $1,167. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,576. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.26x the Medicare baseline. Located in 400 North Pepper Avenue, Colton, CA.

Cash / Self-Pay

$4,576

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,167

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: $4,576 (494%)

Insurance Median: $1,167 (126%)

Cash: $4,576 (494% of Medicare)

Ins. Median: $1,167 (126% 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
Alpha Care	$234	25%
Inland Faculty Medical Group	$234 - $1,167	25%
La Health Care	$234	25%
Lasalle Medical Associates	$234	25%
Physician Health Network	$234	25%
Inland Empire Health Plan	$258 - $1,167	28%
Molina	$314 - $1,342	34%
Innovage	$1,167	126%
Kaiser Foundation	$1,167 - $2,714	126%
Triwest	$1,167	126%
Correctional Health Partners	$1,516	164%
Wellpath	$1,633 - $2,288	176%
Multiplan	$3,295	356%
Blue Cross Blue Shield	$3,318	358%

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 $4,576.
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 Arrowhead Regional 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.