CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Fairview Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$872

about 0.9× the $927 Medicare rate · typically $507–$1,093

modeled estimate · not a bill or quote

What this hospital charges insurers

$869

About the fair price

about $3 under the fair price · 0.9× Medicare

Medicare pays $927 Fair price $872 This hospital $869 Cash price $2,426 Hospital's list price $3,732

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 $869

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 $872 (about 0.9× the $927 Medicare rate). Fairview Hospital charges insurers about $869, or about $2,426 in cash — about the fair price. Located in Cleveland, OH.

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	$634 - $4,831	68%
Blue Cross Blue Shieldmajor	$693 - $2,393	75%
Aetnamajor	$869 - $4,001	94%
Cignamajor	$895 - $2,986	97%
Humanamajor	$786 - $3,172	85%
AmeriHealth	$734	79%
CareSource	$714	77%
Devoted Health	$869	94%
Molina	$701	76%
Oscar Health	$1,124 - $1,435	121%
Paramount	$687	74%
UniCare	$913	99%
UPMC Health Plan	$869 - $2,239	94%
+ 19 smaller / regional plans	$701 - $3,359

Excludes 4 rental-network / third-party entries (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 2,426), 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 Fairview 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 Fairview Hospital

Compare: Upper endoscopy with biopsy at other OH hospitals

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