CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Valleywise Health Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$606

about 0.7× the $927 Medicare rate · typically $356–$931

modeled estimate · not a bill or quote

What this hospital charges insurers

$409

Below the fair price — a good deal

about $197 under the fair price · 0.4× Medicare

Medicare pays $927 Fair price $606 This hospital $409 Cash price $1,113 Hospital's list price $1,505

How we calculate the fair BaseRate →

How this hospital compares to other AZ hospitals

A typical price — 3 charge more and 5 charge less, among the 9 AZ hospitals compared.

Cheapest $125 Priciest $587

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

A fair price for a Upper endoscopy with biopsy is about $606 (about 0.7× the $927 Medicare rate). Valleywise Health Medical Center charges insurers about $409, or about $1,113 in cash — below the fair price — a good deal. Located in Phoenix, AZ.

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✓ Humana Kaiser Permanente

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	$140 - $1,850	15%
Blue Cross Blue Shieldmajor	$122 - $2,270	13%
Aetnamajor	$121 - $1,582	13%
Cignamajor	$147 - $1,922	16%
Humanamajor	$332 - $968	36%
Banner Health	$122 - $968	13%
Devoted Health	$122 - $968	13%
Health Net	$103 - $1,851	11%
Molina	$130 - $1,065	14%
Oscar Health	$140 - $3,500	15%
+ 12 smaller / regional plans	$49 - $1,878

Government programs also on file: Military & VA.

Excludes 1 rental-network / third-party entry (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 1,113), 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 Valleywise Health Medical Center 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 Valleywise Health Medical Center

Compare: Upper endoscopy with biopsy at other AZ hospitals

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