CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Adventist Health Tulare

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $137
Cash Discount Price: $89
vs. Medicare Baseline: 0.15x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Adventist Health Tulare is $137. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.15x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$137

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: $89 (10%)

Insurance Median: $137 (15%)

Cash: $89 (10% of Medicare)

Ins. Median: $137 (15% 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
Blue Shield Mcare	$124	13%
Fhcn Pace Mcr Adv - All Plans	$124	13%
Medicare (plans)	$124	13%
Tricare	$124	13%
UnitedHealthcare	$124 - $182	13%
Upn-United Physcn Ntwrk Mcr Adv Profee Only-All Ot	$124	13%
Ah Employee Health Plan - All Plans	$137	15%
Incentive Hlth - All Plans	$137	15%
Aetna	$154	17%
Hs Interplan-All Plans	$155	17%
Cal Forensic Med Grp - All Plans	$162	17%
Cigna	$171	18%
Healthnet Hmo/Ppo - All Other Plans	$181	20%
Blue Cross Blue Shield	$385	42%
Blue Shield Epn	$621	67%
Blue Shield-All Other Plans	$656	71%

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 $89.
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 Adventist Health Tulare 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.