CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Modoc Medical Center

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $2,034
Cash Discount Price: $2,474
vs. Medicare Baseline: 2.20x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Modoc Medical Center is $2,034. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,474. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 2.20x the Medicare baseline. Located in 1111 N Nagle Street, Alturas, CA.

Cash / Self-Pay

$2,474

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,034

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: $2,474 (267%)

Insurance Median: $2,034 (220%)

Cash: $2,474 (267% of Medicare)

Ins. Median: $2,034 (220% 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 220% of the Medicare baseline (a markup of 120%). 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
Adv Med Mgmt - All Plans	$234	25%
Medi-Cal	$234	25%
Medi-Cal 7/1/24	$234	25%
Partnership Hp - All Plans	$820	88%
Multiplan Wc	$880	95%
Ntwrks By Design Wc - All Plans	$917	99%
Integrated Hp Wc	$927	100%
Blue Shield Mcr Adv	$1,340	145%
Blue Shield Va	$1,340	145%
UnitedHealthcare	$1,340 - $2,350	145%
Tricare	$1,410	152%
Healthnet Mcr Adv	$1,424	154%
Blue Shield Comm - All Other Plans	$1,800	194%
Blue Cross Blue Shield	$2,034 - $2,260	220%
Blue Shield Exch	$2,034	220%
Carelon - All Plans	$2,260	244%
Corvel - All Plans	$2,326	251%
Aetna	$2,350	254%
Coventry/First Health - All Plans	$2,350	254%
Galaxy Health - All Plans	$2,350	254%
Healthnet Comm - All Other Plans	$2,350	254%
Hmn - All Plans	$2,350	254%
Integrated Hp - All Other Plans	$2,350	254%
Interplan - All Plans	$2,350	254%
Multiplan - All Other Plans	$2,350	254%
Superior Ca Ppo - All Plans	$2,350	254%

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 $2,474.
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 Modoc 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.