CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Ascension St Vincent Randolph

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$273

about 0.3× the $927 Medicare rate · typically $154–$2,010

modeled estimate · not a bill or quote

What this hospital charges insurers

$274

About the fair price

about $1 over the fair price · 0.3× Medicare

Medicare pays $927 Fair price $273 This hospital $274

How we calculate the fair BaseRate →

How this hospital compares to other IN hospitals

Highest price of the 9 IN hospitals we have prices for — worth calling around.

Cheapest $116 Priciest $274

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 $273 (about 0.3× the $927 Medicare rate). Ascension St Vincent Randolph charges insurers about $274 — about the fair price. Located in Winchester, IN.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Humana CignaKaiser 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	$56 - $460	6%
Blue Cross Blue Shieldmajor	$270 - $460	29%
Aetnamajor	$460	50%
Humanamajor	$460	50%
Ambetter (Centene)	$460	50%
CareSource	$460	50%
+ 9 smaller / regional plans	$270 - $460

Government programs also on file: Medicare, Medicaid.

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 Ascension St Vincent Randolph 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 Ascension St Vincent Randolph

Compare: Upper endoscopy with biopsy at other IN hospitals

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