CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Providence Regional Medical Center Everett

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$2,056

about 2.2× the $927 Medicare rate · typically $1,416–$2,396

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,905

About the fair price

about $151 under the fair price · 2.1× Medicare

Medicare pays $927 Fair price $2,056 This hospital $1,905

How we calculate the fair BaseRate →

How this hospital compares to other WA hospitals

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

Cheapest $124 Priciest $1,905

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

A fair price for a Upper endoscopy with biopsy is about $2,056 (about 2.2× the $927 Medicare rate). Providence Regional Medical Center Everett charges insurers about $1,905 — about the fair price. Located in Everett, WA.

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✓ Kaiser Permanente Humana

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	$1,085 - $3,203	117%
Blue Cross Blue Shieldmajor	$1,116 - $2,292	120%
Aetnamajor	$1,064 - $8,846	115%
Cignamajor	$8,002	864%
Kaiser Permanentemajor	$1,033 - $1,549	111%
Amerigroup	$1,136	123%
Providence Health Plan	$2,396	259%
+ 3 smaller / regional plans	$1,653 - $3,065

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 Providence Regional Medical Center Everett 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 (%)

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Other Procedures at Providence Regional Medical Center Everett

Compare: Upper endoscopy with biopsy at other WA hospitals

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