CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Avita Ontario

Billing Code: 43239 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$994

about 1.1× the $927 Medicare rate · typically $869–$1,131

modeled estimate · not a bill or quote

Medicare pays $927 Fair price $994 Cash price $3,516 Hospital's list price $4,136

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.

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	$1,317 - $3,516	142%
Blue Cross Blue Shieldmajor	$1,356 - $3,518	146%
Aetnamajor	$2,761 - $3,588	298%
Cignamajor	$3,222	348%
Humanamajor	$1,424 - $3,518	154%
AmeriHealth	$1,383	149%
CareSource	$1,317	142%
Medical Mutual	$2,816 - $3,588	304%
Molina	$1,317 - $5,629	142%
+ 3 smaller / regional plans	$1,317 - $3,518

Government programs also on file: Medicare, Medicaid.

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 3,516), 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 Avita Ontario 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 Avita Ontario

Compare: Upper endoscopy with biopsy at other OH hospitals

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