CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Oro Valley Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$1,269

about 1.4× the $927 Medicare rate · typically $692–$1,408

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,403

About the fair price

about $134 over the fair price · 1.5× Medicare

Medicare pays $927 Fair price $1,269 This hospital $1,403 Cash price $4,685 Hospital's list price $19,520

How we calculate the fair BaseRate →

How this hospital compares to other AZ hospitals

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

Cheapest $125 Priciest $1,403

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

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Upper endoscopy with biopsy is about $1,269 (about 1.4× the $927 Medicare rate). Oro Valley Hospital charges insurers about $1,403, or about $4,685 in cash — about the fair price. Located in Oro Valley, AZ.

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✓ 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	$952 - $2,517	103%
Blue Cross Blue Shieldmajor	$968 - $3,608	104%
Aetnamajor	$952 - $3,709	103%
Cignamajor	$952 - $3,883	103%
Humanamajor	$952	103%
Ambetter (Centene)	$1,365	147%
Banner Health	$1,000	108%
Clover Health	$978	106%
Devoted Health	$981	106%
Health Net	$2,032	219%
WellCare	$1,000	108%
+ 12 smaller / regional plans	$610 - $11,712

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 6 rental-network / third-party entries (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 4,685), 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 Oro Valley 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 Oro Valley Hospital

Compare: Upper endoscopy with biopsy at other AZ hospitals

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