CMS Price Transparency Data
Upper endoscopy with biopsy
Facility: Clovis Community Medical Center
Billing Code: 43239 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 43239
- Insurance Median: $448
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.48x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Clovis Community Medical Center is $448. 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 0.48x the Medicare baseline. Located in 2755 Herndon Ave, Clovis, CA.
Cash / Self-Pay
Unavailable
Average discount available for prompt cash payment at this facility.
Insurance Median
$448
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: $448 (48%)
Ins. Median: $448 (48% 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 |
|---|---|---|
| Ccs Kings | $234 | 25% |
| Generic Care Out of County | $234 | 25% |
| Blue Cross Blue Shield | $234 - $5,447 | 25% |
| Medi-Cal Partnership Health Plan of Ca | $234 | 25% |
| Ccs Fresno | $234 | 25% |
| Medi-Cal Community Health Group | $234 | 25% |
| Medi-Cal Kern Family Health | $234 | 25% |
| Medi-Cal Molina | $234 | 25% |
| Blue Shield | $234 - $4,696 | 25% |
| Santa Clara Family Health Plan - Valley Health | $234 | 25% |
| Generic Ccs Other Counties | $234 | 25% |
| Ccs Madera/Sacramento | $234 | 25% |
| Gold Coast Medi-Cal | $234 | 25% |
| Medi-Cal Contra Costa Health Plan | $234 | 25% |
| Santa Clara Family Health Plan - Premier Health | $234 | 25% |
| Genetically Handicapped Person | $234 | 25% |
| Ccs Mariposa | $234 | 25% |
| Medi-Cal Blue Shield Promise Health | $234 | 25% |
| Medi-Cal Alameda Alliance for Health | $234 | 25% |
| Medi-Cal Health Plan of San Mateo | $234 | 25% |
| San Francisco Health Plan Medi-Cal | $234 | 25% |
| Cal Caloptima | $234 | 25% |
| Medi-Cal La Care Health | $234 | 25% |
| Ccs Merced | $234 | 25% |
| Ccs Tulare | $234 | 25% |
| Fresno County Funded Specialty Care | $234 | 25% |
| Chdp | $234 | 25% |
| Ccs Stanislaus | $234 | 25% |
| Ccs Kern | $234 | 25% |
| Medi-Cal California Health & Wellness Plan | $234 | 25% |
| Medi-Cal Inland Empire Health | $234 | 25% |
| Medi-Cal Cencal Health | $234 | 25% |
| Sequoia Pace | $351 | 38% |
| Health Plan of San Joaquin | $351 | 38% |
| Sante | $363 - $1,167 | 39% |
| Adventist -McL Calviva Sub Cap | $386 | 42% |
| Healthnet HMO - Sante | $448 - $1,167 | 48% |
| Meritage Brand New Day | $448 - $1,167 | 48% |
| Sante Sub Cap-Blue Shield/Sante | $448 - $1,167 | 48% |
| Hartford Life Supplement | $448 - $1,167 | 48% |
| Healthnet Sante - Sub Cap Dual Risk | $448 - $1,167 | 48% |
| Railroad Part B | $448 - $1,167 | 48% |
| Gemcare HMO | $448 - $1,167 | 48% |
| Cares Act Provider Relief Fund | $448 - $1,167 | 48% |
| Blue Shield Saint Agnes | $448 - $1,167 | 48% |
| Blue Shield 65 Plus HMO First Choice | $448 - $1,167 | 48% |
| Sante-Healthnet Seniority | $448 - $1,167 | 48% |
| Healthnet HMO - La Salle | $448 - $1,167 | 48% |
| Blue Shield Sante | $448 - $1,167 | 48% |
| Railroad Part A | $448 - $1,167 | 48% |
| Aetna | $448 - $4,494 | 48% |
| Victims of Crime | $448 - $1,167 | 48% |
| Healthnet Sante Dual Risk | $448 - $1,167 | 48% |
| Humana | $448 - $1,167 | 48% |
| Meritage Blue Shield 65 Plus | $448 - $1,167 | 48% |
| Blue Shield 65 Plus HMO Ehs | $448 - $1,167 | 48% |
| Bscphp - Dhmso | $448 - $1,167 | 48% |
| Scan Health Plan | $448 - $1,167 | 48% |
| Meritage Healthnet HMO | $448 - $1,167 | 48% |
| Cigna | $448 - $5,494 | 48% |
| Sante-Blue Shield/Sante | $448 - $1,167 | 48% |
| Advantek Table Mountain Rancheria Tribal Member | $448 - $1,167 | 48% |
| Blue Shield Hmo-Cvmp/Medpro | $448 - $1,167 | 48% |
| Sequoia Pace - Peak Tpa | $448 - $1,167 | 48% |
| Healthnet HMO - Cvmp/Medpro | $448 - $1,167 | 48% |
| Brand New Day | $448 - $1,167 | 48% |
| Generic Victims of Crime | $448 - $1,167 | 48% |
| Generic | $448 - $1,167 | 48% |
| Sante Sub Cap Healthnet Seniority | $448 - $1,167 | 48% |
| UnitedHealthcare | $448 - $3,982 | 48% |
| Railroad Part A & B | $448 - $1,167 | 48% |
| Care1St HMO - Ehs | $448 - $1,167 | 48% |
| Generic Bscphp | $448 - $1,167 | 48% |
| Healthnet HMO - Dhmso | $448 - $1,167 | 48% |
| Us Marshal | $448 - $1,167 | 48% |
| Bscphp - First Choice | $448 - $1,167 | 48% |
| Well Path (Cfmg) | $448 | 48% |
| Wellcare | $448 - $1,167 | 48% |
| Sante-Sub Cap Ma Brand New Day | $448 - $1,167 | 48% |
| Medicare (plans) | $448 - $1,167 | 48% |
| Bscphp HMO - First Choice | $448 - $1,167 | 48% |
| Todays Pyramid | $448 - $1,167 | 48% |
| Healthnet Sante | $448 - $1,167 | 48% |
| Blue Shield Promise - Imperial | $448 - $1,167 | 48% |
| Medi-Cal Innovative Integrated Health | $448 - $1,167 | 48% |
| Healthnet | $451 | 49% |
| Champion Health Plan of California Ma | $493 - $1,283 | 53% |
| Innovative Integrated Health Community Plans HMO | $493 - $1,283 | 53% |
| Alignment Health Plan | $493 - $1,283 | 53% |
| Imperial Health Plan HMO | $515 - $1,342 | 56% |
| Correctcare Integrated Health | $582 - $1,516 | 63% |
| Coalinga State Hospital | $896 - $2,333 | 97% |
| Kaiser | $927 | 100% |
| Naphcare Inc-Mendota | $963 - $2,508 | 104% |
| Generic Multiplan | $8,490 | 916% |
| PHCS | $8,490 | 916% |