CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Valley Children's Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $1,050
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Valley Children's Hospital is $1,050. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 1.13x the Medicare baseline. Located in 9300 Valley Childrens Place, Madera, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,050

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%)

Insurance Median: $1,050 (113%)

Ins. Median: $1,050 (113% 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
Allcare Ipa	$336	36%
Kaiser	$340	37%
Dignity Ipa_Formerly Img	$470	51%
La Salle Ipa	$470	51%
Sante Ipa	$470	51%
Central Valley Medical Providers Ipa	$504	54%
Sequoia Health Ipa	$504	54%
Univseral Healthcare Ipa	$504	54%
United Physicians Network Ipa	$521	56%
Community Care Ipa	$531	57%
Central California Alliance For Health	$683	74%
Blue Cross Blue Shield	$1,417 - $7,508	153%
Adventist	$1,715	185%
Health Net	$1,811	195%
Cencal Health	$2,075	224%
Kern Family Health Care	$3,063	331%
Blue Shield	$8,441 - $9,287	911%
UnitedHealthcare	$9,553 - $12,100	1031%
Community Care Health Plan	$9,937	1072%

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 $X.
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 Valley Children's 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.