CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Inova Mount Vernon Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,933

about 2.1× the $927 Medicare rate · typically $1,031–$2,590

modeled estimate · not a bill or quote

What this hospital charges insurers

$2,162

About the fair price

about $229 over the fair price · 2.3× Medicare

Medicare pays $927 Fair price $1,933 This hospital $2,162 Cash price $1,484 Hospital's list price $2,968

How we calculate the fair BaseRate →

How this hospital compares to other VA hospitals

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

Cheapest $813 Priciest $2,162

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

A fair price for a Upper endoscopy with biopsy is about $1,933 (about 2.1× the $927 Medicare rate). Inova Mount Vernon Hospital charges insurers about $2,162, or about $1,484 in cash — about the fair price. Located in Alexandria, VA.

What each insurance company pays

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

6 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	$938 - $2,857	101%
Blue Cross Blue Shieldmajor	$938 - $2,510	101%
Aetnamajor	$938 - $3,645	101%
Cignamajor	$975 - $1,917	105%
Humanamajor	$1,031 - $1,504	111%
Kaiser Permanentemajor	$975 - $2,315	105%
Sentara	$956 - $2,431	103%
+ 1 smaller / regional plan	$2,149 - $2,589

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 1,484), 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 Inova Mount Vernon 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 Inova Mount Vernon Hospital

Compare: Upper endoscopy with biopsy at other VA hospitals

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