CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Glenn Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $5,402
Cash Discount Price: $2,153
vs. Medicare Baseline: 5.83x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Glenn Medical Center is $5,402. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,153. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 5.83x the Medicare baseline. Located in 1133 W Sycamore St, Willows, CA.

Cash / Self-Pay

$2,153

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,402

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: $2,153 (232%)

Insurance Median: $5,402 (583%)

Cash: $2,153 (232% of Medicare)

Ins. Median: $5,402 (583% 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 583% of the Medicare baseline (a markup of 483%). 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
Medi-Cal	$234	25%
Ca Health And Wellness - All Plans	$260	28%
UnitedHealthcare	$1,801 - $4,801	194%
Humana	$2,341	253%
Blue Cross Blue Shield	$2,364 - $5,402	255%
Blue Shield Exch	$4,861	525%
Cigna	$5,102	551%
First Health - All Plans	$5,102	551%
Healthnet - All Plans	$5,102	551%
Beech Street - All Plans	$5,402	583%
Blue Shield Ppo/Hmo - All Other Plans	$5,402	583%
Dept Of Corrections - All Plans	$5,402	583%
Galaxy Health Network - All Plans	$5,402	583%
Interplan - All Plans	$5,402	583%
Pacific Health Alliance - All Plans	$5,402	583%
Pponext - All Plans	$5,402	583%
Superior Ca Ppo - All Plans	$5,402	583%
Integrated Hp - All Plans	$5,582	602%
Health Mgmt Network - All Plans	$5,702	615%
Networks By Design - All Plans	$5,702	615%
Three Rivers - All Plans	$5,702	615%

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 $2,153.
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 Glenn Medical Center 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.