CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Wellstar Spalding Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$2,080

about 2.2× the $927 Medicare rate · typically $886–$3,563

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,689

Below the fair price — a good deal

about $391 under the fair price · 1.8× Medicare

Medicare pays $927 Fair price $2,080 This hospital $1,689 Cash price $1,406 Hospital's list price $3,604

How we calculate the fair BaseRate →

How this hospital compares to other GA hospitals

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

Cheapest $158 Priciest $1,689

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

A fair price for a Upper endoscopy with biopsy is about $2,080 (about 2.2× the $927 Medicare rate). Wellstar Spalding Medical Center charges insurers about $1,689, or about $1,406 in cash — below the fair price — a good deal. Located in Griffin, GA.

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✓ Blue Cross Blue Shield✓ Aetna✓ Cigna HumanaKaiser 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	$5,272	569%
Blue Cross Blue Shieldmajor	$928 - $3,467	100%
Aetnamajor	$910 - $4,714	98%
Cignamajor	$955 - $3,437	103%
Ambetter (Centene)	$1,601	173%
CareSource	$1,783	192%
Clover Health	$973	105%
Oscar Health	$1,547	167%
+ 2 smaller / regional plans	$1,683 - $1,694

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 1,406), 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 Wellstar Spalding 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 Wellstar Spalding Medical Center

Compare: Upper endoscopy with biopsy at other GA hospitals

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