CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Loma Linda University Medical Center-Murrieta

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,465
Cash Discount Price: $1,465
vs. Medicare Baseline: 1.58x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Loma Linda University Medical Center-Murrieta is $1,465. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,465. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.58x the Medicare baseline. Located in 28062 Baxter Road, Murrieta, CA.

Cash / Self-Pay

$1,465

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,465

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: $1,465 (158%)

Insurance Median: $1,465 (158%)

Cash: $1,465 (158% of Medicare)

Ins. Median: $1,465 (158% 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.

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
Inland Empire Health Plan (Iehp)	$379 - $1,191	41%
Trivalley Medical Group	$425	46%
Kaiser Foundation Hospitals	$562 - $1,481	61%
Adventist Health	$621 - $681	67%
Lluh Dept Of Risk Management	$776 - $851	84%
UnitedHealthcare	$1,028 - $3,544	111%
Alpha Care Medical Group	$1,191 - $1,787	129%
Dignity Health	$1,191 - $1,787	129%
Epic Health Plan	$1,191 - $9,616	129%
Vantage Medical Group	$1,191 - $1,787	129%
Heritage Provider Network	$1,465 - $2,305	158%
Molina Healthcare Of Ca	$1,501	162%
Multiplan	$1,898 - $2,554	205%
Cigna	$2,018	218%
Aetna	$2,133	230%
Blue Cross Blue Shield	$4,959	535%
Blue Shield Of California	$7,178 - $8,962	775%

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 $1,465.
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 Loma Linda University Medical Center-Murrieta 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.