CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Kenmore Mercy Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$303

about 0.3× the $927 Medicare rate · typically $161–$659

modeled estimate · not a bill or quote

What this hospital charges insurers

$160

Below the fair price — a good deal

about $143 under the fair price · 0.2× Medicare

Medicare pays $927 Fair price $303 This hospital $160 Cash price $751 Hospital's list price $1,193

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

One of the lower prices — 6 of 8 other NY hospitals charge more for the same procedure.

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 $303 (about 0.3× the $927 Medicare rate). Kenmore Mercy Hospital charges insurers about $160, or about $751 in cash — below the fair price — a good deal. Located in Kenmore, 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 - $152	10%
Blue Cross Blue Shieldmajor	$101 - $192	11%
Aetnamajor	$138	15%
Cignamajor	$131 - $191	14%
Humanamajor	$138	15%
Amerigroup	$101	11%
Fidelis Care	$138 - $158	15%
Independent Health	$101 - $204	11%
Molina	$227	24%
MVP Health Care	$172	19%
UPMC Health Plan	$237	26%
WellCare	$138 - $145	15%
+ 16 smaller / regional plans	$101 - $604

Government programs also on file: Medicare, Medicaid, Military & VA.

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 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 Kenmore Mercy 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 Kenmore Mercy Hospital

Compare: Upper endoscopy with biopsy at other NY hospitals

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