Upper endoscopy with biopsy
Facility: Adventist Health Lodi Memorial
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $292
- Cash Discount Price: $29
- vs. Medicare Baseline: 0.32x 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 |
|---|---|---|
| Medcore(Omni Ipa) Op Only- All Plans | $89 - $402 | 10% |
| Blue Shield Epn - All Other Plans | $111 - $621 | 12% |
| Blue Shield Non-Epn | $116 - $656 | 13% |
| Alignment Health Plan (Ahp)-All Plans | $124 - $1,196 | 13% |
| Blue Shield Mcare Adv | $124 - $1,196 | 13% |
| Healthnet Mcare | $124 - $1,196 | 13% |
| Hp Of San Joaquin Mcr Adv | $124 - $1,196 | 13% |
| Humana | $124 - $1,196 | 13% |
| Knnex Health - All Plans | $124 - $1,436 | 13% |
| Tricare | $124 - $1,196 | 13% |
| UnitedHealthcare | $124 - $4,954 | 13% |
| Hp Healthy Kids Pro Fee | $130 | 14% |
| Ah Employee Health Plan - All Plans | $137 - $2,153 | 15% |
| Kaiser Commercial - All Other Plans | $141 - $634 | 15% |
| First Health- All Plans | $149 - $1,082 | 16% |
| Beech Street- All Plans | $162 - $1,391 | 17% |
| Hp Of San Joaquin Ppo - All Other Plans | $162 - $1,469 | 17% |
| Multiplan- All Plans | $162 - $1,237 | 17% |
| Cigna | $163 - $1,391 | 18% |
| Kaiser Mcr Adv | $168 - $1,196 | 18% |
| Networks By Design- All Plans | $168 - $773 | 18% |
| Healthnet- All Other Plans | $169 - $759 | 18% |
| Western Growers- All Plans | $178 - $1,237 | 19% |
| Aetna | $223 - $16,197 | 24% |
| Kaiser Mcal | $234 | 25% |
| Medi-Cal | $234 | 25% |
| Blue Cross Blue Shield | $249 - $1,241 | 27% |
| Hp Of San Joaquin Mcal | $293 | 32% |
| Three Rivers Provider Network- All Plans | $310 - $1,391 | 33% |
| Healthnet Mcal | $335 | 36% |
| Celtic Ins Company - All Plans | $344 - $370 | 37% |
| Bc Mcal | $463 | 50% |
| Cca Health Plan Mcr Adv- All Plans | $1,196 | 129% |
| Bright Health - All Plans | $2,393 | 258% |