CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Scripps Memorial Hospital - Encinitas

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,211

about 1.3× the $927 Medicare rate · typically $952–$1,322

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,167

About the fair price

about $44 under the fair price · 1.3× Medicare

Medicare pays $927 Fair price $1,211 This hospital $1,167 Cash price $649 Hospital's list price $2,597

How we calculate the fair BaseRate →

How this hospital compares to other CA hospitals

Highest price of the 9 CA hospitals we have prices for — worth calling around.

Cheapest $125 Priciest $1,167

Black dot = this hospital, among the 9 CA hospitals with a price for this procedure. Full list below.

A fair price for a Upper endoscopy with biopsy is about $1,211 (about 1.3× the $927 Medicare rate). Scripps Memorial Hospital - Encinitas charges insurers about $1,167, or about $649 in cash — about the fair price. Located in Encinitas, CA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$129 - $2,208	14%
Blue Cross Blue Shieldmajor	$390 - $2,317	42%
Aetnamajor	$129 - $2,226	14%
Cignamajor	$390 - $2,182	42%
Humanamajor	$1,167	126%
Kaiser Permanentemajor	$1,167 - $1,481	126%
Health Net	$390 - $2,916	42%
HealthPartners	$449 - $2,119	48%
+ 41 smaller / regional plans	$208 - $2,338

Government programs also on file: Medicare, Medicaid.

Excludes 4 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 649), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Scripps Memorial Hospital - Encinitas is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Scripps Memorial Hospital - Encinitas

Compare: Upper endoscopy with biopsy at other CA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.