CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Shriners Hospitals for Children Northern Calif

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $675
Cash Discount Price: $3,813
vs. Medicare Baseline: 0.73x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Shriners Hospitals for Children Northern Calif is $675. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,813. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.73x the Medicare baseline. Located in 2425 Stockton Boulevard, Sacramento, CA.

Cash / Self-Pay

$3,813

Average discount available for prompt cash payment at this facility.

Insurance Median

$675

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: $3,813 (411%)

Insurance Median: $675 (73%)

Cash: $3,813 (411% of Medicare)

Ins. Median: $675 (73% 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
Amerigroup Nv	$127	14%
Ambetter / Centene	$141 - $1,354	15%
Health Plan Of Nv	$141	15%
Aetna	$336 - $1,486	36%
Blue Cross Blue Shield	$336 - $4,100	36%
Central California Alliance For Health	$336	36%
Health Plan Of San Joaquin	$336	36%
Kaiser Permanente	$336 - $1,177	36%
Molina Healthcare Of Ca	$336	36%
Partnership Healthplan Of Ca	$336	36%
Northbay Healthcare	$1,177	127%
Cigna	$1,248	135%
Sutter Medical Foundation	$1,295	140%
Health Net Of Ca	$1,354	146%
Sana Benefits	$1,648	178%
UnitedHealthcare	$1,689	182%
Providence Health Plan	$4,501	486%

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 $3,813.
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 Shriners Hospitals for Children Northern Calif 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.