CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Scripps Memorial Hospital La Jolla
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $1,167
- Cash Discount Price: $649
- vs. Medicare Baseline: 1.26x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Scripps Memorial Hospital La Jolla is $1,167. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $649. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.26x the Medicare baseline. Located in 9888 Genesee Avenue, La Jolla, CA.
Cash / Self-Pay
$649
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: $649 (70%)
Insurance Median: $1,167 (126%)
Cash: $649 (70% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $129 - $2,226 | 14% |
| UnitedHealthcare | $129 - $2,208 | 14% |
| Radys Cpmg [803] | $208 | 22% |
| Blue Cross Blue Shield | $390 - $2,317 | 42% |
| Cigna | $390 - $2,182 | 42% |
| Mc Alignment [917] | $390 - $1,299 | 42% |
| Mc Blue Shield Promise Health Plan [914] | $390 - $1,299 | 42% |
| Mc Blue Shield [902] | $390 - $1,299 | 42% |
| Mc Health Net [904] | $390 - $1,299 | 42% |
| Mc Scan [905] | $390 - $1,299 | 42% |
| Mc United [906] | $390 - $1,299 | 42% |
| Sharp Comm Med Grp [812] | $436 - $2,226 | 47% |
| Sharp Rees Stealy Med Grp [811] | $436 - $2,226 | 47% |
| Ucsd [807] | $436 - $2,226 | 47% |
| Uh [819] | $442 - $2,208 | 48% |
| Bc [814] | $449 - $2,119 | 48% |
| Imperial County Phys Med Group [855] | $449 - $2,119 | 48% |
| Integrated Health Partners [894] | $449 - $2,119 | 48% |
| Perlman Med Group [899] | $449 - $2,119 | 48% |
| Blue Shield [230] | $452 - $2,106 | 49% |
| Health Net [340] | $462 - $2,916 | 50% |
| Hn [815] | $462 - $2,104 | 50% |
| Bs [816] | $468 - $2,106 | 51% |
| Centivo [581] | $468 - $2,208 | 51% |
| Palomar Health [892] | $525 - $2,226 | 57% |
| Veba Med Grp [813] | $525 - $2,226 | 57% |
| Kaiser Northern Ca Region Hmo/Ppo [384] | $990 - $1,299 | 107% |
| Kaiser [380] | $990 - $1,299 | 107% |
| Kaiser [383] | $990 - $1,299 | 107% |
| Rady Children'S Hospital [825] | $1,065 - $1,662 | 115% |
| Astiva Mcr Adv [464] | $1,167 | 126% |
| Bc Mcr Adv [830] | $1,167 | 126% |
| Bs Mcr Adv [829] | $1,167 | 126% |
| Central Health Mcr Adv [441] | $1,167 | 126% |
| Clever Care Mcr Adv [465] | $1,167 | 126% |
| D-Snp Mcr Adv [889] | $1,167 | 126% |
| Dsnp/Csnp - Generic [458] | $1,167 | 126% |
| Family Health Centers Pace Mcr Adv Hmo [556] | $1,167 | 126% |
| Family Health Centers Pace Medi-Cal [555] | $1,167 | 126% |
| Gary And Mary West Pace Medi-Cal Hmo [557] | $1,167 | 126% |
| Gpmg/Altura - Mcr Adv [888] | $1,167 | 126% |
| Hn Mcr Adv [832] | $1,167 | 126% |
| Humana | $1,167 | 126% |
| Integrated Health Partners - Mcr Adv [895] | $1,167 | 126% |
| Kaiser Northern Ca Region Mcr Adv [386] | $1,167 | 126% |
| La Care Mcr Adv Hmo [612] | $1,167 | 126% |
| Medicare (plans) | $1,167 | 126% |
| Mpmg Mcr Adv [836] | $1,167 | 126% |
| Mpmg [800] | $1,167 | 126% |
| Ocn Mcr Adv [890] | $1,167 | 126% |
| San Diego Pace Medi-Cal [553] | $1,167 | 126% |
| Scan Mcr Adv [835] | $1,167 | 126% |
| Scan [500] | $1,167 | 126% |
| Scan [818] | $1,167 | 126% |
| Sharp Comm Med Grp Mcr Adv [840] | $1,167 | 126% |
| Sharp Health Plan Mcr Adv [531] | $1,167 | 126% |
| Sharp Health Plan Mcr Adv [897] | $1,167 | 126% |
| Sharp Rees Stealy Med Grp Mcr Adv [841] | $1,167 | 126% |
| St Paul'S Pace Medi-Cal [551] | $1,167 | 126% |
| Ucsd Mcr Adv [873] | $1,167 | 126% |
| Uh Mcr Adv [831] | $1,167 | 126% |
| Uh Palomar Health Mcr Adv [885] | $1,167 | 126% |
| Alignment Health Plan [443] | $1,202 | 130% |
| Multi Plan Network [470] | $1,844 - $2,338 | 199% |
| First Health Network [330] | $1,948 - $2,338 | 210% |
| Pnoa [615] | $1,948 | 210% |
| Prime Healthcare [614] | $1,983 | 214% |
| Prospect Med Group [893] | $2,041 | 220% |
| Choice Care Network [270] | $2,078 | 224% |
| Healthsmart [350] | $2,078 - $2,338 | 224% |
| Managed Health Network Mcr Adv [621] | $2,078 | 224% |
| Managed Health Network [620] | $2,078 | 224% |
| Managed Health Network [862] | $2,078 | 224% |