CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Adventist Health Bakersfield

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $175
Cash Discount Price: $70
vs. Medicare Baseline: 0.19x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Adventist Health Bakersfield is $175. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $70. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.19x the Medicare baseline. Located in 2615 Chester Avenue, Bakersfield, CA.

Cash / Self-Pay

$70

Average discount available for prompt cash payment at this facility.

Insurance Median

$175

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: $70 (8%)

Insurance Median: $175 (19%)

Cash: $70 (8% of Medicare)

Ins. Median: $175 (19% 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 Shield Mcr Adv	$125	13%
Fhcn Pace Mcr Adv - All Plans	$125	13%
Gem Care- All Plans	$125	13%
Healthnet Mcr Adv	$125	13%
Kern Legacy Share Select	$125	13%
Oscar - All Plans	$125	13%
Premier Physician Alliance Profee Only-All Plans	$125	13%
UnitedHealthcare	$125 - $182	13%
County Of Kern - All Plans	$138	15%
Employee Health Plan - All Plans	$138	15%
Kern Legacy Hp Epo - All Other Plans	$138	15%
Aetna	$163	18%
Network Provdrs Llc Mcare -All Payers	$163	18%
Western Growers/Pinnacle- All Plans	$174	19%
Cigna	$175	19%
Healthnet Hmo/Pos/Ppo/Epo - All Other Plans	$182	20%
Centivo - All Plans	$188	20%
Bc Medi-Cal	$234	25%
Medi-Cal	$234	25%
Universal Hc Mcal Profee Only	$234	25%
Kern Health Systems Mcal	$330	36%
Blue Cross Blue Shield	$432	47%
Blue Shield Epn	$621	67%
Blue Shield Epo/Ppo	$656	71%
Blue Shield Hmo/Pos - All Other Plans	$656	71%
Universal Health Plan Mcare-All Other Plans	$1,167	126%

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 $70.
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 Adventist Health Bakersfield 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.