CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Hialeah Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$1,473

about 1.6× the $927 Medicare rate · typically $647–$3,157

modeled estimate · not a bill or quote

What this hospital charges insurers

$922

Below the fair price — a good deal

about $551 under the fair price · 1.0× Medicare

Medicare pays $927 Fair price $1,473 This hospital $922 Cash price $2,592 Hospital's list price $2,592

How we calculate the fair BaseRate →

How this hospital compares to other FL hospitals

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

Cheapest $93 Priciest $922

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

A fair price for a Upper endoscopy with biopsy is about $1,473 (about 1.6× the $927 Medicare rate). Hialeah Hospital charges insurers about $922, or about $2,592 in cash — below the fair price — a good deal. Located in Hialeah, FL.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Aetna✓ Cigna✓ Humana Blue Cross Blue ShieldKaiser 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	$283 - $908	31%
Aetnamajor	$177 - $1,866	19%
Cignamajor	$451 - $953	49%
Humanamajor	$645 - $1,187	70%
Ambetter (Centene)	$1,706	184%
AmeriHealth	$1,983	214%
AvMed	$544 - $1,888	59%
Bright Health	$1,107	119%
Devoted Health	$908	98%
Molina	$1,757	190%
Oscar Health	$159	17%
+ 26 smaller / regional plans	$391 - $2,592

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

Excludes 6 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 2,592), 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 Hialeah 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 Hialeah Hospital

Compare: Upper endoscopy with biopsy at other FL hospitals

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