CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Mayers Memorial Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,626
Cash Discount Price: $1,968
vs. Medicare Baseline: 1.75x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Mayers Memorial Hospital is $1,626. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,968. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.75x the Medicare baseline. Located in 43563 Hwy 299 East, Fall River Mills, CA.

Cash / Self-Pay

$1,968

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,626

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: $1,968 (212%)

Insurance Median: $1,626 (175%)

Cash: $1,968 (212% of Medicare)

Ins. Median: $1,626 (175% 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 Ca Va	$118 - $1,545	13%
Blue Shield Mcr Adv	$118 - $1,545	13%
Tricare	$118 - $1,626	13%
Health Net Mcr Adv	$124 - $1,626	13%
Arcadian Health Services-All Plans	$130 - $1,626	14%
Imperial Health Plan-All Plans	$140 - $1,838	15%
Medi-Cal	$234	25%
Partnership Hp-All Plans	$937	101%
Cigna	$1,398 - $2,341	151%
Corvel Ppo-All Plans	$1,398 - $2,341	151%
Coventry/First Health-All Plans	$1,398 - $2,341	151%
Integrated Hp-All Plans	$1,398 - $2,341	151%
Interplan-All Plans	$1,398 - $2,341	151%
Blue Cross Blue Shield	$1,642 - $2,107	177%
Health Net Prison	$1,773	191%
Blue Shield Ca Exchange	$2,107	227%
Blue Shield-All Other Plans	$2,341	253%
Hmn-All Plans	$2,341	253%
Multiplan Phcs-All Plans	$2,341	253%
Pfmc-All Plans	$2,341	253%
Superior Ca-All Plans	$2,341	253%
Health Net-All Other Plans	$2,452	265%
Pacificare-All Plans	$2,464	266%

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 $1,968.
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 Mayers Memorial 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.