CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Washington Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,409

about 1.5× the $927 Medicare rate · typically $995–$2,381

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,327

About the fair price

about $82 under the fair price · 1.4× Medicare

Medicare pays $927 Fair price $1,409 This hospital $1,327 Cash price $2,503 Hospital's list price $3,851

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 $1,327

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 $1,409 (about 1.5× the $927 Medicare rate). Washington Hospital charges insurers about $1,327, or about $2,503 in cash — about the fair price. Located in Fremont, CA.

What each insurance company pays

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

6 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	$1,327 - $3,353	143%
Blue Cross Blue Shieldmajor	$1,294 - $2,954	140%
Aetnamajor	$1,327 - $28,558	143%
Cignamajor	$2,391 - $3,081	258%
Humanamajor	$1,327 - $3,466	143%
Kaiser Permanentemajor	$1,327 - $2,080	143%
Health Net	$770 - $2,322	83%
+ 11 smaller / regional plans	$1,327 - $3,466

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

Excludes 15 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 2,503), 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 Washington Hospital 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 (%)

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Other Procedures at Washington Hospital

Compare: Upper endoscopy with biopsy at other CA hospitals

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