CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Providence St Vincent Medical Center

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,325

about 1.4× the $927 Medicare rate · typically $1,045–$2,425

modeled estimate · not a bill or quote

Medicare pays $927 Fair price $1,325 Cash price $1,548 Hospital's list price $2,064

How we calculate the fair BaseRate →

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Cigna AetnaHumanaKaiser 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	$1,079 - $7,653	116%
Blue Cross Blue Shieldmajor	$3,330	359%
Cignamajor	$13,592	1467%
Moda Health	$2,016 - $5,509	218%
Molina	$1,089 - $1,845	118%
Providence Health Plan	$992 - $7,355	107%
+ 2 smaller / regional plans	$1,008 - $1,099

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 1,548), 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 Providence St Vincent Medical Center 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 Providence St Vincent Medical Center

Compare: Upper endoscopy with biopsy at other OR hospitals

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