CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Santa Rosa Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,672

about 1.8× the $927 Medicare rate · typically $946–$2,679

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,422

Below the fair price — a good deal

about $250 under the fair price · 1.5× Medicare

Medicare pays $927 Fair price $1,672 This hospital $1,422 Cash price $3,481 Hospital's list price $23,208

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 $1,422

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 $1,672 (about 1.8× the $927 Medicare rate). Santa Rosa Medical Center charges insurers about $1,422, or about $3,481 in cash — below the fair price — a good deal. Located in Milton, FL.

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	$932 - $4,502	101%
Blue Cross Blue Shieldmajor	$932 - $3,708	101%
Aetnamajor	$932 - $13,658	101%
Cignamajor	$932 - $5,245	101%
Humanamajor	$668 - $932	72%
Ambetter (Centene)	$2,264	244%
Molina	$733	79%
Oscar Health	$2,855	308%
WellCare	$681 - $979	73%
+ 5 smaller / regional plans	$746 - $11,604

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

Excludes 3 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 3,481), 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 Santa Rosa 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 Santa Rosa Medical Center

Compare: Upper endoscopy with biopsy at other FL hospitals

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