CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Saint Joseph Regional Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence
A fair price for this
$160
about 0.2× the $927 Medicare rate · typically $74–$955
modeled estimate · not a bill or quote
What this hospital charges insurers
$166
About the fair price
about $6 over the fair price · 0.2× Medicare
Medicare pays $927 Fair price $160 This hospital $166 Hospital's list price $345

How we calculate the fair BaseRate →

How this hospital compares to other IN hospitals

On the higher side — 7 of 8 other IN hospitals charge less.

Cheapest $116 Priciest $177

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

A fair price for a Upper endoscopy with biopsy is about $160 (about 0.2× the $927 Medicare rate). Saint Joseph Regional Medical Center charges insurers about $166 — about the fair price. Located in Mishawaka, IN.

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 $57 - $959 6%
Blue Cross Blue Shieldmajor $57 - $3,388 6%
Aetnamajor $57 - $1,487 6%
Cignamajor $57 - $393 6%
Humanamajor $57 - $191 6%
Kaiser Permanentemajor $158 - $214 17%
Ambetter (Centene) $62 - $166 7%
CareSource $76 - $1,487 8%
Clover Health $57 - $191 6%
GEHA $116 - $306 13%
Health Net $58 - $393 6%
HealthPartners $62 - $166 7%
Meridian $57 - $960 6%
Molina $62 - $166 7%
Paramount $62 - $166 7%
Presbyterian $57 - $191 6%
Tufts Health Plan $62 - $166 7%
WellMed $57 - $191 6%
WellSense $62 - $166 7%
+ 348 smaller / regional plans $57 - $3,388
Government programs also on file: Medicare, Medicaid, Military & VA.
Excludes 10 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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Facility Profile & Credentials

  • Address: 5215 Holy Cross Pkwy, Mishawaka, IN 46545
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals