CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Adventist Health Castle

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$1,064

about 1.1× the $927 Medicare rate · typically $244–$1,218

modeled estimate · not a bill or quote

What this hospital charges insurers

$161

Below the fair price — a good deal

about $903 under the fair price · 0.2× Medicare

Medicare pays $927 Fair price $1,064 This hospital $161 Cash price $109 Hospital's list price $342

How we calculate the fair BaseRate →

How this hospital compares to other HI hospitals

One of the lower prices — 6 of 8 other HI hospitals charge more for the same procedure.

Cheapest $139 Priciest $1,142

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

A fair price for a Upper endoscopy with biopsy is about $1,064 (about 1.1× the $927 Medicare rate). Adventist Health Castle charges insurers about $161, or about $109 in cash — below the fair price — a good deal. Located in Kailua, HI.

What each insurance company pays

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

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

✓ UnitedHealthcare Blue Cross Blue ShieldAetnaCignaHumanaKaiser 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	$125	13%
Devoted Health	$129	14%
+ 8 smaller / regional plans	$125 - $342

Government programs also on file: Medicare, Medicaid.

Excludes 4 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 109), 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 Adventist Health Castle 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 Adventist Health Castle

Compare: Upper endoscopy with biopsy at other HI hospitals

Kau Hospital · Pahala $139
Samuel Mahelona Memorial Hospital · Kapaa $139
Kohala Hospital · Kapaau $925
Kapiolani Medical Center for Women & Children · Honolulu $984
Kaiser Foundation Hospital · Honolulu $1,008
Straub Clinic and Hospital · Honolulu $1,134
Kona Community Hospital · Kealakekua $1,135
North Hawaii Community Hospital, Inc · Kamuela $1,142

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