CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Highland Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,164
Cash Discount Price: $934
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Highland Hospital is $1,164. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $934. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.26x the Medicare baseline. Located in 1411 East 31St Street, Oakland, CA.

Cash / Self-Pay

$934

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,164

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: $934 (101%)

Insurance Median: $1,164 (126%)

Cash: $934 (101% of Medicare)

Ins. Median: $1,164 (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
Blue Cross Blue Shield	$203 - $4,837	22%
Kaiser Medi-Cal Managed Care [1026106]	$234	25%
Aetna	$539 - $1,290	58%
Alameda Alliance Commercial Alternate [4801]	$648	70%
Alameda Alliance Mgd Mcal Alternate [2801]	$648	70%
Alameda Alliance Non-Verified [1002303]	$648	70%
Alameda Alliance [1002106]	$648	70%
Alameda Alliance [1002206]	$648	70%
Mc Alameda Alliance Capitation [1002103]	$648	70%
UnitedHealthcare	$675 - $771	73%
Blue Shield [1006001]	$988 - $1,164	107%
Kaiser Commercial [1026001]	$1,214	131%
Brown Toland Medical Group Alternate [1049301]	$1,290	139%
Brown Toland Medical Group [1049001]	$1,290	139%
Brown Toland Mgd Mcr Alternate [1802]	$1,290	139%
Medicare (plans)	$1,290	139%
Cigna	$1,345	145%
Health Net [1022001]	$3,546	383%

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 $934.
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 Highland 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.