CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Monterey Park Hospital
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 Monterey Park Hospital 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 900 S Atlantic Blvd, Monterey Park, 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
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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 |
|---|---|---|
| Associated Hispanic Physicians Ancillary | $112 - $234 | 12% |
| Access Ipa Ancillary | $143 - $234 | 15% |
| Accountable Ipa | $234 | 25% |
| Allied Physicians | $234 - $1,750 | 25% |
| Alta Med Health Services Corp | $234 - $12,500 | 25% |
| Altamed Health Network | $234 - $1,148 | 25% |
| Applecare Medical Group | $234 - $933 | 25% |
| Assess Ipa | $234 | 25% |
| Beverly Hospital | $234 - $1,283 | 25% |
| Blue Cross Blue Shield | $234 - $2,208 | 25% |
| Brand New Day | $234 - $1,458 | 25% |
| Care 1St Mcl/Gar Cap | $234 | 25% |
| Community Health Plan | $234 | 25% |
| Esperanza Medical Group Ipa | $234 | 25% |
| Family Health Alliance Medical Group | $234 - $1,400 | 25% |
| Health Net Medi Cal | $234 | 25% |
| Healthnet Inc | $234 | 25% |
| Healthy Way La | $234 | 25% |
| La Care | $234 - $1,167 | 25% |
| La Care Health Plan | $234 - $269 | 25% |
| Medical Managed Care Program | $234 | 25% |
| Molina Healthcare | $234 | 25% |
| Other Non-Contracted Medi-Cal | $234 | 25% |
| Preferred Ipa | $234 - $1,458 | 25% |
| Preferred Ipa Of California | $234 | 25% |
| Alhambra Community Dialysis Unit Inc | $302 | 33% |
| Aids Health Foundation | $336 - $1,148 | 36% |
| Bella Vista Medical Group Ancillary | $336 | 36% |
| Central Health Plan | $336 | 36% |
| Emanate Health | $336 - $1,458 | 36% |
| Maxi Med Inc/Ipa | $336 - $1,167 | 36% |
| Medi Cal | $336 | 36% |
| Pacific Independent Physician Association | $336 - $1,400 | 36% |
| Aetna | $462 - $1,148 | 50% |
| Central Health Plan Of California | $484 | 52% |
| Caloptima Direct | $494 | 53% |
| One Health Plan | $500 | 54% |
| Blue Shield Of California | $557 - $1,914 | 60% |
| Molina Medical Centers | $647 | 70% |
| Health Net | $758 - $1,148 | 82% |
| Veterans Administration | $817 | 88% |
| Bella Vista Medical Group | $933 | 101% |
| Senior Citizens Choice | $1,034 | 112% |
| Avanti | $1,050 - $1,400 | 113% |
| Hollywood Presbyterian Adv Med Mcal | $1,050 | 113% |
| Hollywood Presbyterian Medpoint Mcal | $1,050 | 113% |
| Allied Physicians Ipa | $1,100 | 119% |
| Ahmc Healthcare Inc | $1,148 - $1,167 | 124% |
| Apa/Aco Inc | $1,148 | 124% |
| Cms | $1,148 | 124% |
| Easy Choice Health Plan | $1,148 | 124% |
| First Health Senior | $1,148 | 124% |
| Foundation Health Plan | $1,148 | 124% |
| Health Net Inc | $1,148 - $4,086 | 124% |
| Humana | $1,148 | 124% |
| Medicare (plans) | $1,148 - $1,205 | 124% |
| Scan Health Plan | $1,148 | 124% |
| Secure Horizons | $1,148 | 124% |
| Ucla/Impact Cancer | $1,148 | 124% |
| UnitedHealthcare | $1,148 | 124% |
| Ahmc Reciprocity Agreement Senior/Commercial | $1,167 | 126% |
| Cv-19 Hrsa Uninsured Testing And Tx I/P And O/P | $1,167 | 126% |
| La Care Covered Direct | $1,167 | 126% |
| Self-Pay | $1,167 | 126% |
| Tenet Reciprocity | $1,200 | 130% |
| Molina Healthcare Medi-Connect | $1,205 | 130% |
| Universal Care | $1,250 | 135% |
| San Miguel Health Plan | $1,283 | 138% |
| Ahmc Health Epo | $1,458 | 157% |
| Knox-Keene Act | $1,458 | 157% |
| Molina Healthcare Of California | $1,458 | 157% |
| Preferred Health Network | $1,494 | 161% |
| Interplan | $1,525 | 165% |
| Alignment Health Plan | $1,550 | 167% |
| Athens Administrators | $1,572 | 170% |
| Indemnity W Comp Fee Schedule | $1,572 | 170% |
| Multiplan | $1,572 | 170% |
| Choice Care Network | $2,090 | 226% |
| Healthnet | $2,155 | 233% |
| Asi Flex Ppo W/C | $2,500 | 270% |
| Health Net Of California | $3,474 | 375% |
| Care 1St M Cal | $5,000 | 540% |
| Garfield Medical Center | $5,000 | 540% |
| Pacificare | $7,753 - $9,731 | 837% |
| Corvel Corporation | $40,000 | 4317% |