CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: The University of Vermont Health Network-Alice Hy

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$328

about 0.4× the $927 Medicare rate · typically $151–$1,505

modeled estimate · not a bill or quote

What this hospital charges insurers

$253

Below the fair price — a good deal

about $75 under the fair price · 0.3× Medicare

Medicare pays $927 Fair price $328 This hospital $253 Cash price $3,101 Hospital's list price $3,101

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

A typical price — 3 charge more and 5 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 $328 (about 0.4× the $927 Medicare rate). The University of Vermont Health Network-Alice Hy charges insurers about $253, or about $3,101 in cash — below the fair price — a good deal. Located in Malone, NY.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Humana CignaKaiser 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	$228 - $9,020	25%
Blue Cross Blue Shieldmajor	$135 - $3,336	15%
Aetnamajor	$128 - $3,202	14%
Humanamajor	$109 - $1,191	12%
Fidelis Care	$109 - $1,191	12%
MagnaCare	$1,982 - $2,978	214%
MVP Health Care	$109 - $1,743	12%
+ 4 smaller / regional plans	$232 - $3,497

Government programs also on file: Military & VA.

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 3,101), 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 The University of Vermont Health Network-Alice Hy 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 The University of Vermont Health Network-Alice Hy

Compare: Upper endoscopy with biopsy at other NY hospitals

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