CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: San Dimas Community Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,161
Cash Discount Price: $1,160
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at San Dimas Community Hospital is $1,161. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,160. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.25x the Medicare baseline. Located in 1350 W Covina Blvd, San Dimas, CA.

Cash / Self-Pay

$1,160

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,161

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: $1,160 (125%)

Insurance Median: $1,161 (125%)

Cash: $1,160 (125% of Medicare)

Ins. Median: $1,161 (125% 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
Aids Healthcare Foundation	$336 - $1,184	36%
Blue Shield Of Promise	$336	36%
Heritage Provider Network Inc	$336 - $1,509	36%
La Care Health Plan	$336 - $1,161	36%
Molina Healthcare	$336 - $1,161	36%
Traditional Medi-Cal	$336	36%
Blue Cross Blue Shield	$353 - $1,300	38%
Health Net Of Ca	$359 - $1,695	39%
Blue Shield Of Ca	$985 - $1,161	106%
Rios	$1,103	119%
Central Health Plan	$1,161	125%
Choice Physicians Network	$1,161	125%
Citrus Valley Physicians Group	$1,161	125%
Elite Health Plan	$1,161	125%
Health Excel Inc	$1,161	125%
Medicare (plans)	$1,161	125%
Patient Choice Health Plan	$1,161	125%
Primecare Medical Network	$1,161 - $1,509	125%
Renal Payer Solutions	$1,161	125%
Tricare	$1,161	125%
UnitedHealthcare	$1,161 - $1,509	125%
Brand New Day	$1,172 - $1,741	126%
Imperial Health Plan Inc	$1,230	133%
Aetna	$1,483	160%
Ca Foundation For Medical Care	$1,529	165%
Worker Comp	$1,529	165%
Employer Direct Healthcare	$1,625	175%

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 $1,160.
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 San Dimas Community 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.