CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Menifee Global Medical Center
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $3,203
- Cash Discount Price: $4,837
- vs. Medicare Baseline: 3.46x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Menifee Global Medical Center is $3,203. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,837. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 3.46x the Medicare baseline. Located in 28400 McCall Boulevard, Sun City, CA.
Cash / Self-Pay
$4,837
Average discount available for prompt cash payment at this facility.
Insurance Median
$3,203
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: $4,837 (522%)
Insurance Median: $3,203 (346%)
Cash: $4,837 (522% of Medicare)
Ins. Median: $3,203 (346% 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 346% of the Medicare baseline (a markup of 246%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Lasalle Medical Assoc (Ancillary) Mcal Hmo | $276 | 30% |
| Health Net Medi-Cal | $336 | 36% |
| Ic | $336 - $4,837 | 36% |
| Kaiser Medi-Cal | $336 | 36% |
| Prospect Health Plan Mcal Hmo | $346 | 37% |
| Blue Cross Blue Shield | $353 | 38% |
| Tricare | $383 - $4,676 | 41% |
| Molina Medi-Cal | $396 | 43% |
| Altamed Mcal Hmo | $470 | 51% |
| Altamed Mcal/Pace | $470 | 51% |
| Iehp Medi-Cal | $504 | 54% |
| Health Net Enhanced Ppo | $631 - $5,383 | 68% |
| Aetna | $1,161 - $3,845 | 125% |
| Altamed Comm Hmo (Ancillary) | $1,161 - $4,837 | 125% |
| Altamed Health Services Senior | $1,161 - $3,845 | 125% |
| Altamed Sr/Pace | $1,161 - $3,845 | 125% |
| Blue Shield Senior | $1,161 - $3,845 | 125% |
| Central Health Plan Senior | $1,161 - $3,845 | 125% |
| Clever Care Health Plan Sr | $1,161 - $3,845 | 125% |
| For Your Benefit Senior | $1,161 - $3,845 | 125% |
| Guidant Health Plan Senior | $1,161 - $3,845 | 125% |
| Health Net Senior | $1,161 - $3,845 | 125% |
| Hpn Senior | $1,161 - $3,845 | 125% |
| Humana | $1,161 - $3,845 | 125% |
| Kaiser Senior | $1,161 - $3,845 | 125% |
| Lasalle Medical Assoc (Ancillary) Senior | $1,161 - $3,845 | 125% |
| Managed Health Network Sr | $1,161 - $3,845 | 125% |
| Medicare (plans) | $1,161 - $3,845 | 125% |
| Neighborhood Healthcare Pace | $1,161 - $3,845 | 125% |
| Primecare Senior | $1,161 - $3,845 | 125% |
| Prospect Health Plan Sr Hmo | $1,161 - $3,845 | 125% |
| Scan Senior | $1,161 - $3,845 | 125% |
| Sr Capitation | $1,161 - $3,845 | 125% |
| UnitedHealthcare | $1,161 - $3,845 | 125% |
| Veterans Administration | $1,161 - $3,845 | 125% |
| Imperial Health Plan Of Ca | $1,167 - $3,846 | 126% |
| Lasalle Medical Assoc (Ancillary) Commercial | $1,167 - $3,846 | 126% |
| Point Comfort Underwriters | $1,167 - $3,846 | 126% |
| Self Pay/Ab774/Charity Discount | $1,167 - $3,846 | 126% |
| Molina Covered Ca | $1,179 - $4,585 | 127% |
| Align Senior Care | $1,300 - $4,307 | 140% |
| Welbehealth Sr/Pace | $1,300 - $4,307 | 140% |
| Prime Health Services Senior | $1,335 - $4,422 | 144% |
| Coventry | $1,396 - $1,451 | 151% |
| Prime Health Services Wcomp | $1,396 | 151% |
| Iehp Covered Ca | $1,451 - $4,806 | 157% |
| Three Rivers Wcomp | $1,520 | 164% |
| Workers Comp Non-Contracted | $1,551 | 167% |
| Prospect Health Plan Comm Hmo | $1,567 - $5,191 | 169% |
| Hpn Commercial/Covered Ca | $1,625 - $5,383 | 175% |
| Cigna | $1,699 - $3,870 | 183% |
| Health Net Comm | $1,741 - $5,768 | 188% |
| Three Rivers Network | $2,041 - $6,730 | 220% |
| Velocity | $2,041 - $6,730 | 220% |
| First Health Commercial | $2,539 | 274% |
| Hpn Mcal | $2,660 | 287% |
| Choice Physicians Network | $3,144 - $5,200 | 339% |
| Primecare Commercial | $3,144 | 339% |
| Blue Shield Epn | $3,262 - $10,805 | 352% |
| Multiplan Ppo | $3,386 | 365% |
| Multiplan Wcomp | $3,386 | 365% |
| Blue Shield Commercial | $3,842 - $12,727 | 415% |
| Pnoa-Provider Network Of America | $3,870 | 418% |
| Prime Health Services Commercial | $3,870 | 418% |
| Ava Hospice | $4,837 | 522% |
| Kaiser Commercial | $4,837 | 522% |
| Living Waters Hospice | $4,837 | 522% |
| Managed Health Network | $4,837 | 522% |
| Other Insurance Loa | $4,837 | 522% |
| Pacific Valley Hospice | $4,837 | 522% |
| Private Pay | $4,837 | 522% |
| Silverado Hospice | $4,837 | 522% |
| Vna Hospice | $4,837 | 522% |