CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Loma Linda University Children's Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,863
Cash Discount Price: $2,005
vs. Medicare Baseline: 2.01x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Loma Linda University Children's Hospital is $1,863. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,005. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.01x the Medicare baseline. Located in 11234 Anderson Street Suite A, Loma Linda, CA.

Cash / Self-Pay

$2,005

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,863

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: $2,005 (216%)

Insurance Median: $1,863 (201%)

Cash: $2,005 (216% of Medicare)

Ins. Median: $1,863 (201% 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 201% of the Medicare baseline (a markup of 101%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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)	$393 - $1,191	42%
Kaiser Foundation Hospitals	$445 - $3,874	48%
Adventist Health	$621 - $1,162	67%
Lluh Dept Of Risk Management	$745 - $1,394	80%
Alpha Care Medical Group	$1,191 - $1,787	129%
Dignity Health	$1,191 - $1,787	129%
Epic Health Plan	$1,191 - $2,323	129%
Upland Medical Group	$1,191	129%
Vantage Medical Group	$1,191 - $1,787	129%
Trivalley Medical Group	$1,430	154%
Molina Healthcare Of Ca	$1,501 - $1,596	162%
UnitedHealthcare	$1,552 - $7,378	167%
Global Benefits Group	$1,863 - $3,485	201%
Temecula Valley Physicians Medical Group	$1,863	201%
Prime Health Services	$1,879 - $4,937	203%
Multiplan	$1,898 - $4,646	205%
Heritage Provider Network	$1,954	211%
Cigna	$1,987 - $2,298	214%
Networks By Design	$2,018 - $3,775	218%
Blue Shield Of California	$2,470 - $11,231	267%
Galaxy Health	$2,639 - $4,937	285%
Blue Cross Blue Shield	$6,427	694%
Aetna	$7,385	797%

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 $2,005.
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 Children's Hospital 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.