CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Westfield Memorial Hospital Inc

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$362

about 0.4× the $927 Medicare rate · typically $273–$1,000

modeled estimate · not a bill or quote

What this hospital charges insurers

$345

About the fair price

about $17 under the fair price · 0.4× Medicare

Medicare pays $927 Fair price $362 This hospital $345 Cash price $84 Hospital's list price $383

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

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

Cheapest $110 Priciest $345

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 $362 (about 0.4× the $927 Medicare rate). Westfield Memorial Hospital Inc charges insurers about $345, or about $84 in cash — about the fair price. Located in Westfield, 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	$215 - $1,198	23%
Blue Cross Blue Shieldmajor	$119 - $1,840	13%
Aetnamajor	$1,154 - $2,130	125%
Cignamajor	$218	24%
Humanamajor	$1,176	127%
AmeriHealth	$156 - $1,165	17%
Geisinger	$215 - $450	23%
Molina	$1,209	130%
+ 6 smaller / regional plans	$112 - $1,109

Government programs also on file: Medicare.

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 84), 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 Westfield Memorial Hospital Inc 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 (%)

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Other Procedures at Westfield Memorial Hospital Inc

Compare: Upper endoscopy with biopsy at other NY hospitals

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