CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Tri Valley Health System

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$221

about 0.2× the $927 Medicare rate · typically $134–$1,313

modeled estimate · not a bill or quote

What this hospital charges insurers

$266

Above the fair price

about $45 over the fair price · 0.3× Medicare

Medicare pays $927 Fair price $221 This hospital $266 Cash price $796 Hospital's list price $884

How we calculate the fair BaseRate →

How this hospital compares to other NE hospitals

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

Cheapest $122 Priciest $266

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

A fair price for a Upper endoscopy with biopsy is about $221 (about 0.2× the $927 Medicare rate). Tri Valley Health System charges insurers about $266, or about $796 in cash — above the fair price. Located in Cambridge, NE.

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 $221. 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.

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	$266 - $849	29%
Blue Cross Blue Shieldmajor	$115 - $840	12%
Aetnamajor	$121 - $866	13%
Humanamajor	$115 - $389	12%
Amerigroup	$271 - $433	29%
Medica	$115 - $796	12%
Molina	$266 - $424	29%
WellCare	$119 - $389	13%
+ 3 smaller / regional plans	$121 - $424

Government programs also on file: Military & VA.

Excludes 2 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 796), 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 Tri Valley Health System 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 Tri Valley Health System

Compare: Upper endoscopy with biopsy at other NE hospitals

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