CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: University of California Davis Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $3,602
Cash Discount Price: $1,859
vs. Medicare Baseline: 3.89x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at University of California Davis Medical Center is $3,602. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,859. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 3.89x the Medicare baseline. Located in 2315 Stockton Boulevard, Sacramento, CA.

Cash / Self-Pay

$1,859

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,602

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: $1,859 (201%)

Insurance Median: $3,602 (389%)

Cash: $1,859 (201% of Medicare)

Ins. Median: $3,602 (389% 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 389% of the Medicare baseline (a markup of 289%). 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
Dignity/Chw	$129	14%
Adventist	$138	15%
Generic	$138	15%
Healthnet	$138 - $3,602	15%
Blue Shield	$484	52%
Pipe Trades	$484	52%
Sheet Metal Workers Union(Smw)	$484	52%
Ufcw	$484	52%
Blue Cross Blue Shield	$1,177 - $16,400	127%
UnitedHealthcare	$1,222 - $6,297	132%
Blue Shield Senior	$1,236	133%
Healthnet Senior	$1,248	135%
San Joaquin Health Plan Gmc	$1,295	140%
Carpenters H&W	$16,400	1770%
Cement Masons Trust Fund	$16,400	1770%
Delta	$16,400	1770%
Healthcomp	$16,400	1770%
Ironworkers	$16,400	1770%
Joint Benefit Trust	$16,400	1770%
Laborers Health And Welfare	$16,400	1770%
Operating Engrs Health Welfare	$16,400	1770%
Sierra Pacific Industries	$16,400	1770%
Western Growers	$16,400	1770%

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 $1,859.
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 University of California Davis 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.