CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: St Francis Memorial Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$319

about 0.3× the $927 Medicare rate · typically $150–$1,644

modeled estimate · not a bill or quote

What this hospital charges insurers

$145

Below the fair price — a good deal

about $174 under the fair price · 0.2× Medicare

Medicare pays $927 Fair price $319 This hospital $145 Cash price $1,595 Hospital's list price $1,595

How we calculate the fair BaseRate →

How this hospital compares to other NE hospitals

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

Cheapest $122 Priciest $220

Black dot = this hospital, among the 9 NE 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 $319 (about 0.3× the $927 Medicare rate). St Francis Memorial Hospital charges insurers about $145, or about $1,595 in cash — below the fair price — a good deal. Located in West Point, NE.

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	$1,531	165%
Blue Cross Blue Shieldmajor	$142	15%
Aetnamajor	$149 - $1,531	16%
Humanamajor	$142	15%
Medica	$142	15%
Molina	$149	16%
+ 2 smaller / regional plans	$145 - $149

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 (about 1,595), 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 Francis Memorial Hospital 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 Francis Memorial Hospital

Compare: Upper endoscopy with biopsy at other NE hospitals

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