CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Adventist Health Vallejo

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$484

about 0.5× the $927 Medicare rate · typically $195–$1,161

modeled estimate · not a bill or quote

What this hospital charges insurers

$175

Below the fair price — a good deal

about $309 under the fair price · 0.2× Medicare

Medicare pays $927 Fair price $484 This hospital $175 Cash price $68 Hospital's list price $453

How we calculate the fair BaseRate →

How this hospital compares to other CA hospitals

Highest price of the 9 CA hospitals we have prices for — worth calling around.

Cheapest $125 Priciest $175

Black dot = this hospital, among the 9 CA hospitals with a price for this procedure. Full list below.

A fair price for a Upper endoscopy with biopsy is about $484 (about 0.5× the $927 Medicare rate). Adventist Health Vallejo charges insurers about $175, or about $68 in cash — below the fair price — a good deal. Located in Vallejo, CA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Kaiser Permanente Humana

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$175	19%
Blue Cross Blue Shieldmajor	$134 - $451	14%
Aetnamajor	$254	27%
Cignamajor	$171	18%
Kaiser Permanentemajor	$161	17%
+ 4 smaller / regional plans	$134 - $385

Government programs also on file: Medicare, Military & VA.

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 68), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Adventist Health Vallejo is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Adventist Health Vallejo

Compare: Upper endoscopy with biopsy at other CA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.