CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Adventist Health Howard Memorial

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $243
Cash Discount Price: $140
vs. Medicare Baseline: 0.26x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Adventist Health Howard Memorial is $243. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $140. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.26x the Medicare baseline. Located in 1 Marcela Dr, Willits, CA.

Cash / Self-Pay

$140

Average discount available for prompt cash payment at this facility.

Insurance Median

$243

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: $140 (15%)

Insurance Median: $243 (26%)

Cash: $140 (15% of Medicare)

Ins. Median: $243 (26% 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	$94 - $124	10%
Tricare	$94 - $124	10%
Medicare (plans)	$95 - $124	10%
UnitedHealthcare	$103 - $362	11%
Ah Employee Health Plan - All Plans	$137 - $243	15%
Cigna	$163 - $398	18%
Aetna	$164 - $314	18%
Western Growers/Pinnacle - All Plans	$178 - $351	19%
Healthnet - All Plans	$181 - $384	20%
Medi-Cal	$234	25%
First Health Ppo - All Plans	$374	40%
Ghn Ppo - All Plans	$374	40%
Brms - All Plans	$398	43%
Blue Cross Blue Shield	$445 - $10,529	48%
Blue Shield - All Other Plans	$656 - $8,286	71%
Blue Shield Epn	$8,005	864%

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 $140.
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 Howard Memorial 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.