CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Atrium Health Cleveland

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$268

about 0.3× the $927 Medicare rate · typically $173–$905

modeled estimate · not a bill or quote

What this hospital charges insurers

$358

Above the fair price

about $90 over the fair price · 0.4× Medicare

Medicare pays $927 Fair price $268 This hospital $358

How we calculate the fair BaseRate →

How this hospital compares to other NC hospitals

A typical price — 0 charge more and 5 charge less, among the 9 NC hospitals compared.

Cheapest $133 Priciest $358

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

A fair price for a Upper endoscopy with biopsy is about $268 (about 0.3× the $927 Medicare rate). Atrium Health Cleveland charges insurers about $358 — above the fair price. Located in Shelby, NC.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $268. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

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	$131 - $927	14%
Blue Cross Blue Shieldmajor	$358 - $471	39%
Aetnamajor	$130 - $911	14%
Cignamajor	$126 - $924	14%
Humanamajor	$129 - $898	14%
AmeriHealth	$134	14%
WellCare	$134	14%
+ 7 smaller / regional plans	$133 - $378

Excludes 1 rental-network / third-party entry (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, 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 Atrium Health Cleveland 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 Atrium Health Cleveland

Compare: Upper endoscopy with biopsy at other NC hospitals

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