Upper endoscopy with biopsy
Facility: AHMC Seton Medical Center
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $1,360
- Cash Discount Price: $1,727
- vs. Medicare Baseline: 1.47x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Hill Physicians Medical Group Inc | $158 - $336 | 17% |
| Medi-Cal | $234 | 25% |
| San Mateo County/San Mateo County General Hospital | $288 | 31% |
| Self Pay | $324 - $734 | 35% |
| San Francisco Health Plan | $328 | 35% |
| Cmac | $336 | 36% |
| Kaiser | $336 - $1,770 | 36% |
| Jade Health Care Mg | $351 - $1,296 | 38% |
| Asian American Medical Group | $403 - $1,646 | 43% |
| Health Plan Of San Mateo Healthworx | $413 | 45% |
| Brown And Toland Medical Group | $420 - $1,646 | 45% |
| North East Medical Services | $468 - $1,296 | 51% |
| Health Plan Of San Mateo | $470 | 51% |
| Workers Compensation Federal | $810 - $2,159 | 87% |
| Veterans Administration (Va) | $922 | 100% |
| Chinese Community Health Plan | $1,080 - $1,296 | 117% |
| Healthcare Foundation Of San Mateo | $1,187 - $1,727 | 128% |
| Blue Shield Of California | $1,204 - $2,248 | 130% |
| Interplan Corporation | $1,295 - $1,619 | 140% |
| Aetna | $1,296 - $2,134 | 140% |
| Blue Cross Blue Shield | $1,296 - $5,404 | 140% |
| Brand New Day | $1,296 - $1,646 | 140% |
| Care Advantage | $1,296 | 140% |
| For Your Benefit | $1,296 | 140% |
| Healthnet Seniority | $1,296 | 140% |
| Humana | $1,296 | 140% |
| Imperial Health Plan | $1,296 | 140% |
| Medicare (plans) | $1,296 | 140% |
| Pacificare | $1,296 | 140% |
| Tricare | $1,311 | 141% |
| Apcmg | $1,317 - $1,975 | 142% |
| Canopy Health | $1,317 - $2,370 | 142% |
| Covid-19 Uninsured Program | $1,317 | 142% |
| UnitedHealthcare | $1,317 - $6,867 | 142% |
| Easy Choice Hospital Services | $1,343 | 145% |
| Cigna | $1,360 - $2,548 | 147% |
| Central Health Plan | $1,400 | 151% |
| Multiplan/Bce Emergis | $1,619 - $1,751 | 175% |
| Private Healthcare Sytems Inc | $1,619 | 175% |
| The First Health Network | $1,619 | 175% |
| Ahmc Health | $1,646 | 178% |
| Knox-Keene Act | $1,646 | 178% |
| Health Net | $1,656 | 179% |
| Beech Street Corporation | $1,727 | 186% |
| Athens Administrators | $1,751 | 189% |
| Corvel Healthcare | $1,751 | 189% |
| Work Comp Other | $1,751 | 189% |
| Choicecare Network | $1,835 | 198% |
| Multiplan | $1,835 | 198% |
| Mills Peninsula Health Services | $1,943 | 210% |
| Indemnity | $2,159 | 233% |