CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Grady Memorial Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$1,613

about 1.7× the $927 Medicare rate · typically $489–$2,578

modeled estimate · not a bill or quote

What this hospital charges insurers

$518

Below the fair price — a good deal

about $1,095 under the fair price · 0.6× Medicare

Medicare pays $927 Fair price $1,613 This hospital $518

How we calculate the fair BaseRate →

How this hospital compares to other GA hospitals

A typical price — 4 charge more and 4 charge less, among the 9 GA hospitals compared.

Cheapest $158 Priciest $702

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 $1,613 (about 1.7× the $927 Medicare rate). Grady Memorial Hospital charges insurers about $518 — below the fair price — a good deal. Located in Atlanta, GA.

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	$134 - $2,880	14%
Blue Cross Blue Shieldmajor	$134 - $4,275	14%
Aetnamajor	$134 - $2,891	14%
Cignamajor	$134 - $2,836	14%
Humanamajor	$134 - $933	14%
Kaiser Permanentemajor	$134 - $933	14%
Ambetter (Centene)	$134 - $933	14%
Amerigroup	$211	23%
CareSource	$211 - $1,493	23%
Clover Health	$140 - $979	15%
Oscar Health	$190 - $1,547	21%
WellCare	$134 - $933	14%
+ 1 smaller / regional plan	$140 - $979

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

Excludes 1 rental-network / third-party entry (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, 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 Grady Memorial 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 (%)

Enter your details and press estimate to compare.

Other Procedures at Grady Memorial Hospital

Compare: Upper endoscopy with biopsy at other GA hospitals

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