Upper endoscopy with biopsy
Facility: Coastal Communities Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $4,320
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 4.66x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 466% of the Medicare baseline (a markup of 366%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Kpc Healthcare Inc | $281 - $5,401 | 30% |
| Healthcare Partners | $336 | 36% |
| Hollywood Presbyterian | $336 - $4,320 | 36% |
| Kaiser | $336 - $4,320 | 36% |
| Medi-Cal Hmo/Non Contract | $336 | 36% |
| Medicaid / KanCare | $336 | 36% |
| Altamed Health Services | $470 - $4,320 | 51% |
| Caloptima | $470 - $4,321 | 51% |
| Choc Health Alliance | $470 | 51% |
| County Of Orange | $470 | 51% |
| Family Choice | $470 | 51% |
| Heritage Provider Network | $470 - $5,815 | 51% |
| Prospect Health Plan | $470 - $6,481 | 51% |
| Coventry Auto Network | $1,396 | 151% |
| Prime Health Srvs/Wc | $1,396 | 151% |
| Interplan | $1,412 | 152% |
| Coventry Wc | $1,451 | 157% |
| Multiplan | $1,520 - $35,000 | 164% |
| Three Rivers | $1,520 | 164% |
| Velocity National Provider Network Wc | $1,551 | 167% |
| Workers Comp State Of California | $1,551 | 167% |
| Aetna | $2,138 | 231% |
| Monarch | $3,634 - $4,320 | 392% |
| Blue Shield | $4,320 - $16,460 | 466% |
| Central Health Plan Of California | $4,320 | 466% |
| Champion Health Plan | $4,320 | 466% |
| Citizens Choice Health Plan | $4,320 | 466% |
| Clever Care Health Plan | $4,320 | 466% |
| For Your Benefit | $4,320 | 466% |
| Health Net | $4,320 - $7,448 | 466% |
| Healthcare Partners Sr Hmo | $4,320 | 466% |
| Heritage | $4,320 | 466% |
| Humana | $4,320 | 466% |
| Onecare | $4,320 | 466% |
| Onecare Connect | $4,320 | 466% |
| Other Senior Non Contract | $4,320 | 466% |
| Scan Health Plan | $4,320 | 466% |
| UnitedHealthcare | $4,320 - $4,764 | 466% |
| Us Federal Marshall/Department Of Immigration | $4,320 | 466% |
| Velocity Provider Network Sr | $4,320 | 466% |
| Verda Health Plan Sr | $4,320 | 466% |
| Veterans Administration | $4,320 | 466% |
| Choice Physicians Network | $4,321 | 466% |
| Easy Choice Health Plan | $4,321 | 466% |
| Imperial Health Plan Of Ca | $4,321 | 466% |
| Innovative Integrated Health | $4,321 | 466% |
| Medcare Partners | $4,321 | 466% |
| Self Pay Ab774/Cbo Use Only | $4,321 | 466% |
| Us Dept Of Labor | $4,321 | 466% |
| Victim Of Violent Crime | $4,321 | 466% |
| Victoria Hospice | $4,321 | 466% |
| Monarch Health Plan | $4,574 | 494% |
| Champus | $4,676 | 505% |
| Brand New Day | $4,839 | 522% |
| Prime Health Srvs | $4,968 | 536% |
| County Of Orange/Custody/Advanced Medmgt | $5,400 | 583% |
| Veterans Evaluation Services | $5,401 | 583% |
| Cigna | $5,871 | 634% |
| Staywell/Island Home Ins | $6,049 | 653% |
| Three Rivers Network | $7,561 | 816% |
| Velocity National Provider Network Ppo | $7,561 | 816% |
| Ihhi Reciprocity | $15,000 | 1619% |
| Healthsmart | $37,500 | 4047% |