CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Valor Health

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$418

about 0.5× the $927 Medicare rate · typically $156–$1,443

modeled estimate · not a bill or quote

Medicare pays $927 Fair price $418 Cash price $1,499 Hospital's list price $1,578

How we calculate the fair BaseRate →

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	$116 - $1,965	13%
Blue Cross Blue Shieldmajor	$116 - $2,084	13%
Aetnamajor	$119 - $1,776	13%
Cignamajor	$219 - $1,963	24%
Humanamajor	$116 - $2,084	13%
Moda Health	$232 - $2,021	25%
Molina	$116 - $1,000	13%
PacificSource	$116 - $2,021	13%
SelectHealth	$116 - $2,021	13%

Government programs also on file: Military & VA.

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 1,499), 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 Valor Health 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 Valor Health

Compare: Upper endoscopy with biopsy at other ID hospitals

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