CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Chinese Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,383
Cash Discount Price: $7,043
vs. Medicare Baseline: 1.49x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Chinese Hospital is $1,383. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,043. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.49x the Medicare baseline. Located in 845 Jackson St, San Francisco, CA.

Cash / Self-Pay

$7,043

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,383

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: $7,043 (760%)

Insurance Median: $1,383 (149%)

Cash: $7,043 (760% of Medicare)

Ins. Median: $1,383 (149% 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	$234 - $1,837	25%
Medi-Cal	$234	25%
San Francisco Health Plan- All Plans	$234	25%
Hp Of San Mateo Medi-Cal	$288	31%
Hp Of San Mateo Health Kids/Health Worx-All Other	$311	34%
Blue Shield Medi-Cal	$316	34%
Asian Medical Group Medi-Cal Op Only	$328	35%
Jade Medi-Cal	$422	46%
Aetna	$1,311 - $6,264	141%
Cchp Mcr Adv	$1,311	141%
Jade Mcr Adv	$1,311	141%
Jade-All Other Plans	$1,442	156%
On Lok Mcr Adv-All Plans	$1,442	156%
Blue Shield - All Other Plans	$3,219	347%
Health Net-All Plans	$3,733	403%
Cigna	$3,874	418%
Cchp-All Other Plans	$5,987	646%
Hp Of San Mateo Mcr Adv	$6,339	684%
Asian Medical Group Mcare Op Only-All Other Plans	$7,043	760%
Bay Area Accountable Care Mcare	$7,043	760%
Bay Area Accountable Care - All Other Plans	$12,677	1368%

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 $7,043.
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 Chinese 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.