CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Physicians Regional Medical Center - Pine Ridge

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,606

about 1.7× the $927 Medicare rate · typically $1,048–$1,886

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,420

Below the fair price — a good deal

about $186 under the fair price · 1.5× Medicare

Medicare pays $927 Fair price $1,606 This hospital $1,420 Cash price $4,431 Hospital's list price $21,102

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 $1,420

Black dot = this hospital, among the 9 FL 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 $1,606 (about 1.7× the $927 Medicare rate). Physicians Regional Medical Center - Pine Ridge charges insurers about $1,420, or about $4,431 in cash — below the fair price — a good deal. Located in Naples, 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	$649 - $5,107	70%
Blue Cross Blue Shieldmajor	$932 - $4,570	101%
Aetnamajor	$932 - $14,012	101%
Cignamajor	$3,455	373%
Humanamajor	$668 - $932	72%
Ambetter (Centene)	$2,415	261%
Amerigroup	$707	76%
AvMed	$8,019	865%
HealthPartners	$4,878	526%
Simply Healthcare	$688 - $3,000	74%
WellCare	$681 - $976	73%
+ 9 smaller / regional plans	$649 - $2,368

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 4,431), 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 Physicians Regional Medical Center - Pine Ridge 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 Physicians Regional Medical Center - Pine Ridge

Compare: Upper endoscopy with biopsy at other FL hospitals

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