CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Sublette County Health

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$307

about 0.3× the $927 Medicare rate · typically $131–$1,486

modeled estimate · not a bill or quote

What this hospital charges insurers

$121

Below the fair price — a good deal

about $186 under the fair price · 0.1× Medicare

Medicare pays $927 Fair price $307 This hospital $121 Cash price $293 Hospital's list price $325

How we calculate the fair BaseRate →

How this hospital compares to other WY hospitals

One of the lower prices — 6 of 7 other WY hospitals charge more for the same procedure.

Cheapest $101 Priciest $507

Black dot = this hospital, among the 8 WY hospitals with a price for this procedure. Full list below.

A fair price for a Upper endoscopy with biopsy is about $307 (about 0.3× the $927 Medicare rate). Sublette County Health charges insurers about $121, or about $293 in cash — below the fair price — a good deal. Located in Pinedale, WY.

What each insurance company pays

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

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

✓ Blue Cross Blue Shield UnitedHealthcareAetnaCignaHumanaKaiser 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
Blue Cross Blue Shieldmajor	$550	59%
+ 1 smaller / regional plan	$121

Government programs also on file: Military & VA.

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 (about 293), 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 Sublette County Health 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 Sublette County Health

Compare: Upper endoscopy with biopsy at other WY hospitals

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