CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: The Orthopaedic Hospital of Lutheran Health Networ

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,197

about 1.3× the $927 Medicare rate · typically $867–$1,590

modeled estimate · not a bill or quote

Medicare pays $927 Fair price $1,197 Cash price $103 Hospital's list price $383

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	$850 - $960	92%
Blue Cross Blue Shieldmajor	$944 - $3,944	102%
Aetnamajor	$128 - $944	14%
Cignamajor	$115 - $657	12%
Humanamajor	$944	102%
Devoted Health	$963	104%
+ 21 smaller / regional plans	$89 - $2,690

Government programs also on file: Medicare.

Excludes 13 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 103), 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 The Orthopaedic Hospital of Lutheran Health Networ 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 The Orthopaedic Hospital of Lutheran Health Networ

Compare: Upper endoscopy with biopsy at other IN hospitals

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