CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Wilson Memorial Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,225

about 1.3× the $927 Medicare rate · typically $912–$2,061

modeled estimate · not a bill or quote

What this hospital charges insurers

$2,097

Above the fair price

about $872 over the fair price · 2.3× Medicare

Medicare pays $927 Fair price $1,225 This hospital $2,097 Cash price $2,769 Hospital's list price $5,539

How we calculate the fair BaseRate →

How this hospital compares to other OH hospitals

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

Cheapest $175 Priciest $2,097

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

A fair price for a Upper endoscopy with biopsy is about $1,225 (about 1.3× the $927 Medicare rate). Wilson Memorial Hospital charges insurers about $2,097, or about $2,769 in cash — above the fair price. Located in Sidney, OH.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $1,225. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

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	$3,311	357%
Blue Cross Blue Shieldmajor	$883 - $4,758	95%
Aetnamajor	$4,376	472%
Cignamajor	$4,985	538%
Humanamajor	$883	95%
Medical Mutual	$3,093	334%

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 2,769), 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 Wilson Memorial 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 Wilson Memorial Hospital

Compare: Upper endoscopy with biopsy at other OH hospitals

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