CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Marinhealth Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $3,762
Cash Discount Price: $5,665
vs. Medicare Baseline: 4.06x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Marinhealth Medical Center is $3,762. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,665. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 4.06x the Medicare baseline. Located in 250 Bon Air Road, Greenbrae, CA.

Cash / Self-Pay

$5,665

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,762

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: $5,665 (611%)

Insurance Median: $3,762 (406%)

Cash: $5,665 (611% of Medicare)

Ins. Median: $3,762 (406% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 406% of the Medicare baseline (a markup of 306%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$1,280 - $8,796	138%
Brown And Tolan	$1,280	138%
Healthnet Tailored Network	$1,280	138%
Kaiser	$1,280	138%
Marin Cancer Care	$1,280	138%
Canopy Hill Physicians	$1,600	173%
Healthnet Hmo/Ppo Hill Physicians	$1,600	173%
Hills Blue Shield Hmo/Ppo	$1,600	173%
Ca Prison Health Care Services	$2,048	221%
UnitedHealthcare	$2,330	251%
Healthnet Enhancedcare	$3,328	359%
Blue Cross Blue Shield	$4,195 - $5,304	453%
Provider Network Of America	$6,081	656%
Canopy	$7,361	794%
Blue Shield Cpic/Epo	$7,593	819%
Providers Network Of America	$8,065	870%
Blue Shield Hmo/Ppo	$8,436	910%
Healthnet Hmo/Ppo	$8,539	922%
Blue Shield Aco	$8,745	944%
Cigna	$15,538	1677%

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 $5,665.
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 Marinhealth 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.