CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Children's Hosp of Los Angeles
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $689
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.74x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Children's Hosp of Los Angeles is $689. 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 0.74x the Medicare baseline. Located in 4650 Sunset Blvd, Ms 108, Los Angeles, CA.
Cash / Self-Pay
Unavailable
Average discount available for prompt cash payment at this facility.
Insurance Median
$689
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: $689 (74%)
Ins. Median: $689 (74% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Altamed | $328 - $14,719 | 35% |
| Caloptima | $328 | 35% |
| Medi-Cal | $336 | 36% |
| Valley Presbyterian Hospital | $336 | 36% |
| Choc Health Alliance | $420 | 45% |
| Health Net | $420 | 45% |
| St Francis Medical Center | $437 - $648 | 47% |
| Bella Vista Med Grp | $490 | 53% |
| Centinela Valley Ipa | $490 | 53% |
| El Proyecto Del Barrio | $490 | 53% |
| Global Care Medical Group | $490 | 53% |
| Health Care La Ipa | $490 | 53% |
| Premier Physicians Ntwk | $490 | 53% |
| Watts Healthcare Mmc | $490 | 53% |
| Community Family Care Ipa | $504 | 54% |
| Hollywood Presbyterian Medical Center | $504 | 54% |
| Heritage Provider Network | $537 - $17,128 | 58% |
| Blue Cross Blue Shield | $554 - $4,319 | 60% |
| La Care | $558 - $14,987 | 60% |
| Serra Community Med Clinic | $576 | 62% |
| Care 1St | $588 | 63% |
| White Memorial Medical Center | $588 | 63% |
| Adventist Health Physicians | $605 - $16,057 | 65% |
| Cal Care Ipa | $611 | 66% |
| Associated Hispanic Physicians Ipa | $621 | 67% |
| Gold Coast Health Plan | $621 | 67% |
| Hispanic Physician Ipa | $621 | 67% |
| Serendib Healthways Mmc | $621 | 67% |
| Beverly Hospital | $625 | 67% |
| Los Angeles Medical Center Ipa | $628 | 68% |
| San Judas Med Grp | $628 | 68% |
| Alhambra Hospital Medical Center | $632 | 68% |
| Accountable Health | $642 | 69% |
| Souther California Hosp System - Mmc | $644 | 69% |
| Cencal Health | $648 | 70% |
| Pacific Alliance Medical Center | $658 | 71% |
| Blue Shield | $665 - $4,242 | 72% |
| Angeles Ipa | $672 | 73% |
| Crown City Medical Group | $672 | 73% |
| Employee Health Systems Med Grp | $672 | 73% |
| Point Comfort Underwriters | $672 | 73% |
| Seaside Health Plan | $672 | 73% |
| Imperial Health Holdings Medical Group | $685 | 74% |
| Karing Physicians Medical Group | $685 | 74% |
| Noble Community Medical Associates | $685 | 74% |
| Regent Medical Group | $685 | 74% |
| Avalon Ipa | $689 | 74% |
| Exceptional Care Medical Group | $689 - $20,429 | 74% |
| Mabuhay Medical Group | $689 | 74% |
| Preferred Ipa | $689 | 74% |
| Primary Care And Pediatric Ipa | $689 | 74% |
| Inland Empire Health Plan | $692 | 75% |
| Family Care Specialists | $709 | 77% |
| Molina | $709 | 77% |
| Family Health Alliance Med Grp | $722 | 78% |
| Applecare Medical Group | $742 - $17,396 | 80% |
| Community Care Ipa Mmc | $742 | 80% |
| Dignity Health | $746 | 81% |
| Allied Pacific Ipa | $789 | 85% |
| Asian Community Medical Group | $799 | 86% |
| California Pacific Physicians Medical Group | $799 | 86% |
| Healthy New Life Medical Corp | $799 | 86% |
| Kern Family Health Plan | $846 | 91% |
| Superior Choice Medical Group | $910 | 98% |
| Southland San Gabriel Valley Medical Group | $917 | 99% |
| Cigna | $3,495 | 377% |
| Champus | $4,725 | 510% |
| UnitedHealthcare | $6,367 - $11,695 | 687% |
| Medicare (plans) | $8,747 | 944% |
| Accarent Health | $8,921 | 963% |
| Sierra Health And Life Insurance Company | $10,000 | 1079% |
| Delta Health Systems | $11,564 | 1248% |
| Incentive Health Network | $16,504 | 1781% |
| Gemcare Ipa | $17,128 | 1848% |
| Managed Care Systems | $17,396 | 1877% |
| Providence Health Network | $17,842 | 1925% |
| Ventura County Health Plan | $22,748 | 2455% |
| Good Samaritan Medical Group | $24,532 | 2647% |
| Access Medical Group | $24,800 | 2676% |
| Staywell Insurance | $25,000 | 2698% |
| Seoul Medical Group | $27,387 | 2956% |
| Southern Atlantic Medical Group Mmc | $30,422 | 3283% |