CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Whittier Hospital Medical Center
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $1,148
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.24x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Whittier Hospital Medical Center is $1,148. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.24x the Medicare baseline. Located in 9080 Colima Rd, Whittier, CA.
Cash / Self-Pay
Unavailable
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,148
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%)
Insurance Median: $1,148 (124%)
Ins. Median: $1,148 (124% 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.
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 |
|---|---|---|
| Applecare Medical Group | $157 | 17% |
| Ahmc Medi-Cal Reciprocity Agreement | $234 | 25% |
| Aids Healthcare Foundation | $234 - $1,148 | 25% |
| Allied Physicians | $234 - $1,750 | 25% |
| Alta Med Health Network | $234 - $1,148 | 25% |
| Altamed Health Services Corporation | $234 | 25% |
| Beverly Hospital | $234 - $1,283 | 25% |
| Brand New Day | $234 - $1,435 | 25% |
| Emanate Health | $234 - $1,434 | 25% |
| Health Net | $234 - $1,148 | 25% |
| Healthy Way La | $234 | 25% |
| Heritage Provider Network | $234 - $1,575 | 25% |
| Kaiser Foundation | $234 - $4,083 | 25% |
| La Care Healthy Families/Healthy Kids | $234 | 25% |
| Non Contracted Medi-Cal | $234 | 25% |
| Prospect Health Plan | $234 - $1,866 | 25% |
| Synermed | $234 - $1,167 | 25% |
| La Care Health Plan | $269 - $1,148 | 29% |
| Monarch Healthplan | $328 | 35% |
| Avanti | $336 - $1,400 | 36% |
| Care First Health Plan | $336 | 36% |
| County Of Los Angeles Dept Of Health Services | $336 | 36% |
| Hollywood Presbyterian Adv Med Mcal | $336 | 36% |
| Hollywood Presbyterian Medpoint Mcal | $336 | 36% |
| Medi Caid/ Medi Cal | $336 | 36% |
| Central Health Plan Of California | $477 | 51% |
| Pacific Independent Physician Association | $500 - $1,400 | 54% |
| Aetna | $572 - $1,664 | 62% |
| Davita Healthcare Partners | $622 | 67% |
| Medicare (plans) | $635 - $1,205 | 69% |
| UnitedHealthcare | $669 - $3,700 | 72% |
| Molina Medical Center | $682 - $1,458 | 74% |
| Prospect Medical | $700 | 76% |
| Veterans Administration | $817 | 88% |
| Universal Care | $1,100 - $32,500 | 119% |
| Alta Los Angeles Hospitals Inc | $1,148 | 124% |
| Apa/Aco Inc | $1,148 | 124% |
| Blue Cross Blue Shield | $1,148 - $2,372 | 124% |
| Caloptima | $1,148 | 124% |
| Central Health Plan | $1,148 | 124% |
| Easy Choice Health Plan | $1,148 | 124% |
| Humana | $1,148 | 124% |
| Pacificare Of California | $1,148 | 124% |
| Scan Health Plan | $1,148 | 124% |
| Blue Shield Of California | $1,167 - $1,879 | 126% |
| Caremore | $1,167 | 126% |
| Cov19 Hrsa Uninsured Testing And Treatment Fund | $1,167 | 126% |
| La Care Covered Direct | $1,167 | 126% |
| Pacific Alliance Medical Center | $1,167 | 126% |
| Private Pay | $1,167 | 126% |
| Self-Pay | $1,167 | 126% |
| Alignment Health Plan | $1,205 | 130% |
| Molina Healthcare Of California | $1,205 | 130% |
| San Miguel Health Plan | $1,283 | 138% |
| Chinatown Service Center Pace | $1,400 | 151% |
| Ahmc Health | $1,458 | 157% |
| Knox-Keene Act | $1,458 | 157% |
| Fmc Los Angeles County | $1,474 | 159% |
| Interplan Health Group | $1,505 | 162% |
| Athens Administrators Ahmc Work Comp | $1,551 | 167% |
| Misc 1 | $1,551 | 167% |
| Multiplan Wc | $1,551 | 167% |
| Capnet | $2,000 | 216% |
| Edward Medical Group | $2,000 | 216% |
| Great-West Healthcare Of California | $2,500 | 270% |
| Prohealth | $2,500 | 270% |
| Care 1St Health Plan | $2,600 - $4,500 | 281% |
| Cost Containment | $2,800 | 302% |
| Health Net Inc | $2,860 - $2,997 | 309% |
| Healthnet | $3,501 | 378% |
| Tricare | $4,871 | 526% |