CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: St Claire Regional Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$601

about 0.6× the $927 Medicare rate · typically $136–$1,388

modeled estimate · not a bill or quote

What this hospital charges insurers

$151

Below the fair price — a good deal

about $450 under the fair price · 0.2× Medicare

Medicare pays $927 Fair price $601 This hospital $151 Cash price $1,187 Hospital's list price $1,583

How we calculate the fair BaseRate →

How this hospital compares to other KY hospitals

A typical price — 3 charge more and 5 charge less, among the 9 KY hospitals compared.

Cheapest $119 Priciest $342

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

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Upper endoscopy with biopsy is about $601 (about 0.6× the $927 Medicare rate). St Claire Regional Medical Center charges insurers about $151, or about $1,187 in cash — below the fair price — a good deal. Located in Morehead, KY.

What each insurance company pays

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

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

✓ Blue Cross Blue Shield✓ Aetna✓ Humana UnitedHealthcareCignaKaiser 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
Blue Cross Blue Shieldmajor	$119 - $1,921	13%
Aetnamajor	$179 - $499	19%
Humanamajor	$119 - $1,867	13%
CareSource	$119 - $1,222	13%
HealthLink	$126 - $1,849	14%
WellCare	$148 - $2,267	16%
+ 2 smaller / regional plans	$154 - $3,467

Government programs also on file: 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 (about 1,187), 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 St Claire Regional Medical Center 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 St Claire Regional Medical Center

Compare: Upper endoscopy with biopsy at other KY hospitals

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