CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Mercy Hospital of Buffalo

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$289

about 0.3× the $927 Medicare rate · typically $118–$626

modeled estimate · not a bill or quote

What this hospital charges insurers

$313

About the fair price

about $24 over the fair price · 0.3× Medicare

Medicare pays $927 Fair price $289 This hospital $313 Cash price $751 Hospital's list price $1,193

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

On the higher side — 6 of 8 other NY hospitals charge less.

Cheapest $110 Priciest $322

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

A fair price for a Upper endoscopy with biopsy is about $289 (about 0.3× the $927 Medicare rate). Mercy Hospital of Buffalo charges insurers about $313, or about $751 in cash — about the fair price. 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 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 Mercy Hospital of Buffalo 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 Mercy Hospital of Buffalo

Compare: Upper endoscopy with biopsy at other NY hospitals

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