CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Northwest Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,255

about 1.4× the $927 Medicare rate · typically $652–$1,405

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,394

About the fair price

about $139 over the fair price · 1.5× Medicare

Medicare pays $927 Fair price $1,255 This hospital $1,394 Cash price $4,438 Hospital's list price $18,490

How we calculate the fair BaseRate →

How this hospital compares to other AZ hospitals

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

Cheapest $125 Priciest $1,394

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

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Upper endoscopy with biopsy is about $1,255 (about 1.4× the $927 Medicare rate). Northwest Medical Center charges insurers about $1,394, or about $4,438 in cash — about the fair price. Located in Tucson, 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	$952 - $9,245	103%
Blue Cross Blue Shieldmajor	$968 - $3,608	104%
Aetnamajor	$952 - $11,094	103%
Cignamajor	$952 - $3,883	103%
Humanamajor	$952	103%
Ambetter (Centene)	$1,365	147%
Banner Health	$1,000	108%
Clover Health	$978	106%
Devoted Health	$981	106%
Health Net	$1,534	166%
WellCare	$1,000	108%
+ 11 smaller / regional plans	$610 - $2,226

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

Excludes 4 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 4,438), 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 Northwest 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 Northwest Medical Center

Compare: Upper endoscopy with biopsy at other AZ hospitals

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