CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: SSM Health St Anthony Hospital - Midwest

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,310

about 1.4× the $927 Medicare rate · typically $794–$2,195

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,502

About the fair price

about $192 over the fair price · 1.6× Medicare

Medicare pays $927 Fair price $1,310 This hospital $1,502

How we calculate the fair BaseRate →

How this hospital compares to other OK hospitals

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

Cheapest $155 Priciest $1,502

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

A fair price for a Upper endoscopy with biopsy is about $1,310 (about 1.4× the $927 Medicare rate). SSM Health St Anthony Hospital - Midwest charges insurers about $1,502 — about the fair price. Located in Midwest City, OK.

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✓ Cigna✓ Humana AetnaKaiser 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	$1,872	202%
Blue Cross Blue Shieldmajor	$872 - $898	94%
Cignamajor	$2,100	227%
Humanamajor	$887	96%
Ambetter (Centene)	$1,178	127%
Health Net	$1,867 - $1,910	201%
Medica	$209 - $1,411	23%
Oscar Health	$1,148 - $4,387	124%
+ 2 smaller / regional plans	$1,594 - $1,701

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, 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 SSM Health St Anthony Hospital - Midwest 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 SSM Health St Anthony Hospital - Midwest

Compare: Upper endoscopy with biopsy at other OK hospitals

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