Upper endoscopy with biopsy
Facility: Hazel Hawkins Memorial Hospital
Billing Code: 43239 (CPT)
- CPT Billing Code: 43239
- Insurance Median: $3,551
- Cash Discount Price: $1,500
- vs. Medicare Baseline: 3.83x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 383% of the Medicare baseline (a markup of 283%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 Cross Blue Shield | $234 - $4,178 | 25% |
| Kaiser Mcal | $234 | 25% |
| Medi-Cal | $234 | 25% |
| Valley Hp Mcal | $234 | 25% |
| Triwest - All Plans | $299 | 32% |
| Tricare | $309 | 33% |
| Blue Shield Mcare | $315 | 34% |
| Caremore Med Adv - All Plans | $315 | 34% |
| Kaiser Med Adv | $315 | 34% |
| Central Hp Med Adv | $331 | 36% |
| Ccah Mcal - All Plans | $375 | 40% |
| UnitedHealthcare | $1,086 - $3,134 | 117% |
| Valley Hp Covered Ca | $2,193 | 237% |
| Valley Hp Preferred | $2,193 | 237% |
| Kaiser Comm - All Other Plans | $2,465 | 266% |
| Blue Shield Of Ca - All Other Plans | $2,532 | 273% |
| Valley Hp Classic - All Other Plans | $2,632 | 284% |
| Beech Street Corp Ppo - All Plans | $3,551 | 383% |
| Cigna | $3,551 | 383% |
| Corvel Ppo - All Plans | $3,551 | 383% |
| First Health Ppo - All Plans | $3,551 | 383% |
| Great West Ppo - All Plans | $3,551 | 383% |
| Nx Health Network - All Plans | $3,551 | 383% |
| Interplan Ppo - All Plans | $3,677 | 397% |
| Bce Emergis/Multi Ppo - All Plans | $3,760 | 406% |
| Healthnet Hmo | $3,760 | 406% |
| Healthnet Ppo - All Other Plans | $3,760 | 406% |
| Metracomp Wc Ppo - All Plans | $3,760 | 406% |
| One Hp Ppo - All Plans | $3,760 | 406% |
| Admar Ppo - All Plans | $3,802 | 410% |
| Ccn Ppo - All Other Plans | $3,969 | 428% |
| Choicecare Ppo/Hmo - All Plans | $3,969 | 428% |
| Coastal Hlthcre Ppo/Hmo - All Plans | $3,969 | 428% |
| Ccn (W/C) | $4,178 | 451% |
| Central Coast Ppo - All Other Plans | $4,178 | 451% |
| Pacific Hlth Alliance - All Plans | $5,900 | 637% |