CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Sisters of Charity Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$281

about 0.3× the $927 Medicare rate · typically $134–$643

modeled estimate · not a bill or quote

What this hospital charges insurers

$204

Below the fair price — a good deal

about $77 under the fair price · 0.2× Medicare

Medicare pays $927 Fair price $281 This hospital $204 Cash price $751 Hospital's list price $1,193

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

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

Cheapest $110 Priciest $322

Black dot = this hospital, among the 9 NY 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 $281 (about 0.3× the $927 Medicare rate). Sisters of Charity Hospital charges insurers about $204, or about $751 in cash — below the fair price — a good deal. Located in Buffalo, NY.

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	$92 - $403	10%
Blue Cross Blue Shieldmajor	$101 - $508	11%
Aetnamajor	$138 - $358	15%
Cignamajor	$131 - $519	14%
Humanamajor	$138 - $358	15%
Amerigroup	$101 - $355	11%
Fidelis Care	$138 - $430	15%
Independent Health	$101 - $557	11%
MagnaCare	$358	39%
Molina	$227 - $798	24%
MVP Health Care	$172 - $456	19%
UPMC Health Plan	$237 - $374	26%
WellCare	$138 - $394	15%
+ 16 smaller / regional plans	$101 - $628

Government programs also on file: Medicare, Medicaid, 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 751), 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 Sisters of Charity 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 Sisters of Charity Hospital

Compare: Upper endoscopy with biopsy at other NY hospitals

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