CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Sunrise Hospital and Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$439

about 0.5× the $927 Medicare rate · typically $242–$1,076

modeled estimate · not a bill or quote

What this hospital charges insurers

$291

Below the fair price — a good deal

about $148 under the fair price · 0.3× Medicare

Medicare pays $927 Fair price $439 This hospital $291 Cash price $792 Hospital's list price $792

How we calculate the fair BaseRate →

How this hospital compares to other NV hospitals

One of the lower prices — 7 of 8 other NV hospitals charge more for the same procedure.

Cheapest $154 Priciest $1,036

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

A fair price for a Upper endoscopy with biopsy is about $439 (about 0.5× the $927 Medicare rate). Sunrise Hospital and Medical Center charges insurers about $291, or about $792 in cash — below the fair price — a good deal. Located in Las Vegas, NV.

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	$135 - $2,295	15%
Blue Cross Blue Shieldmajor	$131 - $3,720	14%
Aetnamajor	$131 - $2,138	14%
Cignamajor	$172 - $2,482	19%
Humanamajor	$97 - $2,704	10%
Ambetter (Centene)	$2,550 - $2,626	275%
Amerigroup	$92 - $171	10%
CareSource	$343	37%
Molina	$97 - $343	10%
SelectHealth	$263 - $5,307	28%
+ 13 smaller / regional plans	$92 - $4,260

Excludes 3 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 792), 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 Sunrise Hospital and 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 Sunrise Hospital and Medical Center

Compare: Upper endoscopy with biopsy at other NV hospitals

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