CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Saint Alphonsus Medical Center Ontario

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 43239
  • Insurance Median: $185
  • Cash Discount Price: $449
  • vs. Medicare Baseline: 0.20x Medicare
The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Saint Alphonsus Medical Center Ontario is $185. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $449. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.20x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.
Cash / Self-Pay
$449

Average discount available for prompt cash payment at this facility.

Insurance Median
$185

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$926.63

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $926.63 (100%)
Cash / Self-Pay: $449 (48%)
Insurance Median: $185 (20%)
Cash: $449 (48% of Medicare)
Ins. Median: $185 (20% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $926.63 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group Contract Rate Range vs. Medicare Reference
Aetna $54 - $449 6%
Albany County Correctional Facility $54 - $294 6%
Ambetter / Centene $54 - $294 6%
Amish Mennonite $54 - $294 6%
Ascension St. Vincent Public Safety Medical $54 - $294 6%
Bcccp-Michigan $54 - $294 6%
Bccp $54 - $294 6%
Blue Cross Blue Shield $54 - $398 6%
Bmc Healthnet $54 - $294 6%
Breast Grant-Connecticut $54 - $294 6%
Broward County Dept Of Health $54 - $294 6%
California Health And Wellness $54 - $294 6%
Can Community Health Inc $54 - $294 6%
Cardinal Innovations Lme $54 - $294 6%
Care Connections Of Northern Iowa $54 - $294 6%
Care Oregon Ohp $54 - $294 6%
Cencal Health Plan $54 - $294 6%
Cenpatico $54 - $294 6%
Chhuny $54 - $294 6%
Childrens Comm Health Plan $54 - $294 6%
Childrens Medical Services Title 19 $54 - $294 6%
Cigna $54 - $294 6%
City Of Philadelphia $54 - $294 6%
Cmh Allegan County $54 - $294 6%
Cmh Ausable Valley $54 - $294 6%
Cmh Barry County $54 - $294 6%
Cmh Bay-Arenac County $54 - $294 6%
Cmh Berrien County $54 - $294 6%
Cmh Cass County $54 - $294 6%
Cmh Central Mi County $54 - $294 6%
Cmh Clinton-Eaton-Ingham County $54 - $294 6%
Cmh Detroit Wayne Integrated Health Network $54 - $294 6%
Cmh Genesee County $54 - $294 6%
Cmh Ionia County $54 - $294 6%
Cmh Jackson County/Lifeways $54 - $294 6%
Cmh Kalamazoo $54 - $294 6%
Cmh Kent County $54 - $294 6%
Cmh Lenawee County $54 - $294 6%
Cmh Livingston County $54 - $294 6%
Cmh Macomb $54 - $294 6%
Cmh Misc $54 - $294 6%
Cmh Monroe County $54 - $294 6%
Cmh Montcalm County $54 - $294 6%
Cmh Muskegon County $54 - $294 6%
Cmh Newaygo County $54 - $294 6%
Cmh North Country $54 - $294 6%
Cmh Northern Lakes County $54 - $294 6%
Cmh Oakland County $54 - $294 6%
Cmh Ottawa County $54 - $294 6%
Cmh Van Buren County $54 - $294 6%
Cmh Washtenaw County $54 - $294 6%
Cmh Wayne County/Carelink $54 - $294 6%
Cmh Wayne Cty/Com Liv Svcs $54 - $294 6%
Cmh West Mi County $54 - $294 6%
Community Benefit Health $54 - $294 6%
Community Care Behavorial Health $54 - $294 6%
Community Care Partners $54 - $294 6%
Community Health Choice $54 - $294 6%
Connections Csp $54 - $294 6%
County Coroner $54 - $294 6%
County Funding Generic $54 - $294 6%
Covid19 Hrsa Uninsured Testing And Treatment Fund $54 - $294 6%
Dean Wi Badgercare $54 - $294 6%
Delaware County Department Of Health $54 - $294 6%
Delaware First Health $54 - $294 6%
Delta Dental Nj $54 - $294 6%
Dph Tb Program $54 - $294 6%
Dscc $54 - $294 6%
Eastpointe Lme $54 - $294 6%
Family Health Network $54 - $294 6%
Freedom First Healthcare $54 - $294 6%
Fresno County Ccs $54 - $294 6%
Ghc Scw Wi Badgercare $54 - $294 6%
Harbor Health $54 - $294 6%
Health Safety Net $54 - $294 6%
Healthy Blue Ne $54 - $294 6%
Hennepin Health $54 - $294 6%
Humana $54 - $446 6%
Id County Ada $54 - $294 6%
Id County Canyon $54 - $294 6%
Id County Cat Fund $54 - $294 6%
Id County Other $54 - $294 6%
Id County Payette $54 - $294 6%
Idaho Dept Health And Wellfare $54 - $294 6%
Idaho Womens Health Check $54 - $294 6%
Indiana Breast Cervical Cancer $54 - $294 6%
Inland Empire Health Plan $54 - $294 6%
Intercommunity Health Ohp $54 - $294 6%
Iowa Total Care $54 - $294 6%
Jai Medical System $54 - $294 6%
Kern Family Health Plan $54 - $294 6%
Keystone First $54 - $294 6%
Keystone First Chip $54 - $294 6%
La Care Health Plan $54 - $294 6%
Lakeland Care Inc $54 - $294 6%
Managed Health Services - Indiana $54 - $294 6%
Maryland Breast & Cervical Program $54 - $294 6%
Maryland Healthy Smiles - Scion Dental $54 - $294 6%
Maryland Physicians Care $54 - $294 6%
Massachusetts Behavioral Health Partnership $54 - $294 6%
Mdwise $54 - $294 6%
Medi-Cal $54 - $294 6%
Medi-Cal Healthnet $54 - $294 6%
Medicaid / KanCare $54 - $294 6%
Medstar Dc Healthy Family $54 - $294 6%
Medstar Md Health Choice $54 - $294 6%
Mo Home State Health Plan $54 - $294 6%
Molina Centennial Care $54 - $294 6%
Nascentia Health Options $54 - $294 6%
Nebraska Total Care $54 - $294 6%
New York Cancer Services Program $54 - $294 6%
Nextlevel Health $54 - $294 6%
Oregon Screenwise $54 - $147 6%
Pace Of Southwest Michigan $54 - $294 6%
Paramount Advantage $54 - $294 6%
Parkland Community Health Plan $54 - $294 6%
Partners Behavioral Lme $54 - $294 6%
Peach State Healthplan $54 - $294 6%
Philadelphia County Funding $54 - $294 6%
Presbyterian Centennial Care $54 - $294 6%
Prestige Health Choice $54 - $294 6%
Priority Partners $54 - $294 6%
Robert F Sing Program $54 - $294 6%
Rx 340B Pass Along $54 - $294 6%
Rx Assistance/Rx Manufacturer Assistance 0 Copay $54 - $294 6%
Rx Medi-Cal $54 - $294 6%
Rx Meridian Rx $54 - $294 6%
Ryan White Florida Mssrp $54 - $294 6%
Sandhills Center Lme $54 - $294 6%
Screening For Life $54 - $294 6%
St Joseph County Hlth Dpt $54 - $294 6%
Stephenson Cty Health $54 - $294 6%
Sunshine State Health Plan $54 - $294 6%
Superior Health $54 - $294 6%
Tenncare $54 - $294 6%
Texas Children'S Health Plan $54 - $294 6%
Trillium Community Ohp $54 - $294 6%
Tufts Health Public Plans $54 - $294 6%
UnitedHealthcare $54 - $393 6%
Vaya Health Lme $54 - $294 6%
Washtenaw Health Plan $54 - $294 6%
Wellsense Health Plan $54 - $294 6%
Wi Womens Wellness $54 - $294 6%
Align Senior Care $59 - $203 6%
Ally Align Care Adv $59 - $203 6%
American Health Plan $59 - $203 6%
Aurora Special Needs $59 - $203 6%
Blue Care Network Advantage $59 - $203 6%
Blue Shield - De (Highmark) Medciare Advantage $59 - $203 6%
Care Dimensions $59 - $203 6%
Care Improvement Plus $59 - $203 6%
Care Resources Pace $59 - $203 6%
Careplus Health Plans $59 - $203 6%
Cca - Zing Health $59 - $203 6%
Cca Senior Care Options $59 - $203 6%
Central Valley Medical Services Corp Pace $59 - $203 6%
Champion Health Plan Mcr Advantage $59 - $203 6%
Clear Spring Health $59 - $203 6%
Clover Health $59 - $203 6%
Commonwealth Care Alliance $59 - $203 6%
Community Pace At Home $59 - $203 6%
Eddy Senior Care-Pace $59 - $203 6%
Eddy Seniorcare Pace $59 - $203 6%
Elementcare $59 - $203 6%
Evercare $59 - $203 6%
Everence $59 - $203 6%
Gateway Health Plan $59 - $203 6%
Genesys Pace Of Genesee County $59 - $203 6%
Georgia Health Advantage $59 - $203 6%
Gold Advantage $59 - $203 6%
Gpa Croell Redi Mix $59 - $203 6%
Health America Advantra $59 - $203 6%
Highmark Health Options Dual Plan $59 - $203 6%
Hope Select Pace $59 - $203 6%
Horizon Nj Total Care $59 - $203 6%
Hudson Headwaters Pace $59 - $203 6%
Huron Valley Pace $59 - $203 6%
Innovative Integrated Health Community Plans $59 - $203 6%
Iowa Health Advantage $59 - $203 6%
Johns Hopkins Advantage Md $59 - $203 6%
Lasso Healthcare Msa $59 - $203 6%
Life St Marys Pace $59 - $203 6%
Lifecircles Pace $59 - $203 6%
Longevity Health Plan $59 - $203 6%
Longevity Ipa Of Michigan Llc Health Plan Isnp $59 - $203 6%
Martins Point Generations Advantage $59 - $203 6%
Mass General Brigham Mcr Adv $59 - $203 6%
Medicare (plans) $59 - $228 6%
Medipak Advantage $59 - $203 6%
Mercy Life $59 - $203 6%
Mercyone Cedar Valley $59 - $203 6%
Meridian Complete $59 - $203 6%
Michigan Complete Health $59 - $203 6%
Nascentia Health Plus $59 - $203 6%
New Centry Health Careplus $59 - $203 6%
Osu Prime Care Advantage $59 - $203 6%
Pace Cny $59 - $203 6%
Pace Iowa Immanuel Pathways $59 - $203 6%
Pace Southeast $59 - $203 6%
Pace-Trinity Health $59 - $203 6%
Peak Pace Solutions $59 - $203 6%
Perennial Advantage $59 - $203 6%
Preferred Care Partners $59 - $203 6%
Presbyterian Senior Plan $59 - $203 6%
Provider Partners Health Plan Of Illinois $59 - $203 6%
Provider Partners Health Plan Of Indiana $59 - $203 6%
Pruitthealth Premier $59 - $203 6%
Reliance Community Care Partners Care Resources Pace $59 - $203 6%
Rx Allwin $59 - $203 6%
Rx Grane Grnmedd $59 - $203 6%
Rx Retiree Rx Care $59 - $203 6%
Scan Health Plan Mcr Ipa Meritage Oon $59 - $203 6%
Secure Horizons Ma Pffs $59 - $203 6%
Serenity Pace $59 - $203 6%
Siouxland Pace $59 - $203 6%
Solis Health Plans $59 - $203 6%
Sunnyview-Pace Finance Dept $59 - $203 6%
Texan Plus $59 - $203 6%
The Health Plan $59 - $203 6%
Thome Pace $59 - $203 6%
Todays Options $59 - $203 6%
Tribute Health Plans $59 - $203 6%
Um Health Advantage $59 - $203 6%
Union Health Service $59 - $203 6%
Welbe Health $59 - $203 6%
Wellmed $59 - $203 6%
Veterans Administration $60 - $207 6%
American Health Advantage Of Idaho $62 - $214 7%
Champva $64 - $175 7%
Tricare $64 - $175 7%
Triwest Health Alliance $64 - $175 7%
Us Family Health Plan $64 - $175 7%
Veterans Eval Services $64 - $175 7%
Webtpa $109 - $373 12%
Molina Marketplace $118 - $404 13%
Pacificsource Health Plans $131 - $364 14%
Moda Health $132 - $361 14%
Mountain Health Co-Op $132 - $361 14%
Selecthealth $132 - $440 14%
Bcn Domestic $139 - $398 15%
Blue Benefit Administrators Of Massachusetts $139 - $398 15%
Blue Care Network $139 - $398 15%
Blue Distinction Transplant $139 - $398 15%
Blue Shield - Ca $139 - $398 15%
Blue Shield - Id (Regence) $139 - $404 15%
Blue Shield - Ny Highmark Northeastern $139 - $398 15%
Blue Shield - Ny Highmark Western $139 - $398 15%
Blue Shield - Pa (Highmark) $139 - $398 15%
Blue Shield - Wa (Regence) $139 - $398 15%
Health Choices $139 - $398 15%
Kaiser Domestic $139 - $398 15%
Pre-Employment $139 - $398 15%
Wc Domestic $139 - $398 15%
First Choice Health $140 - $374 15%
Providence $140 - $374 15%
Asuris Northwest Health $145 - $404 16%
Healthcare Management Admin $145 - $404 16%
Geha $148 - $393 16%
Allied National Global Care $169 - $419 18%
Asrm - Reliance Standard Life Insurance $169 - $419 18%
Christian Care Ministry $169 - $419 18%
Dean Health $169 - $419 18%
Fallon Health $169 - $419 18%
Family Life Insurance Company $169 - $419 18%
Ghc Scw $169 - $419 18%
International Benefit Administrators $169 - $419 18%
Lifetime Benefit Solutions $169 - $419 18%
Manhattan Life $169 - $419 18%
Medi Share $169 - $419 18%
Multiplan $169 - $419 18%
Pai $169 - $419 18%
Pan-American Life $169 - $419 18%
Paramount Hmo $169 - $419 18%
Phcs $169 - $419 18%
Trinity Health Share $169 - $419 18%
Andrie Inc $185 - $449 20%
East Greenbush Central School District $185 - $449 20%
Genex Wc $185 - $449 20%
Healthsmart Workers Comp $185 - $449 20%
Jag Source $185 - $449 20%
New York State Insurance Fund $185 - $449 20%
Njm Insurance Group $185 - $449 20%
Rx Heatlhcomp $185 - $449 20%
Rx Restat $185 - $449 20%
Rx Saif Opdp Wc $185 - $449 20%
Rx Worker'S Comp $185 - $449 20%
Wc Accident Fund $185 - $449 20%
Wc Ace $185 - $449 20%
Wc Acs Federal Employees $185 - $449 20%
Wc Acuity $185 - $449 20%
Wc Advantage $185 - $449 20%
Wc Aegis $185 - $449 20%
Wc Aig $185 - $449 20%
Wc Aims $185 - $449 20%
Wc Alaska National Ins $185 - $449 20%
Wc Align Network $185 - $449 20%
Wc Allied $185 - $449 20%
Wc Am Trust N America $185 - $449 20%
Wc American Claims Mgmt $185 - $449 20%
Wc Amerisure $185 - $449 20%
Wc Amtrust $185 - $449 20%
Wc Asu Risk Mgt $185 - $449 20%
Wc Benetech $185 - $449 20%
Wc Berkley Admin $185 - $449 20%
Wc Broadspire $185 - $449 20%
Wc Broward County $185 - $449 20%
Wc Bunch & Associates $185 - $449 20%
Wc California State Comp Ins $185 - $449 20%
Wc California State Ins Fund $185 - $449 20%
Wc Capitol Area Health Consortium $185 - $449 20%
Wc Ccmsi $185 - $449 20%
Wc Chartis $185 - $449 20%
Wc Chubb $185 - $449 20%
Wc Cirma $185 - $449 20%
Wc City Of Albany $185 - $449 20%
Wc City Of Sioux City $185 - $449 20%
Wc Claims Mgmt Inc $185 - $449 20%
Wc Cna $185 - $449 20%
Wc Comp One Admin C/O Manageability $185 - $449 20%
Wc Compone Admin $185 - $449 20%
Wc Corvel $185 - $449 20%
Wc Ct Healthcare Trust $185 - $449 20%
Wc Donegal Insurance Group $185 - $449 20%
Wc Emc Insurance Company $185 - $449 20%
Wc Employee Mutual $185 - $449 20%
Wc Enablecomp $185 - $449 20%
Wc Encore Health Network $185 - $449 20%
Wc Erie $185 - $449 20%
Wc Esis $185 - $449 20%
Wc Evolutions $185 - $449 20%
Wc Fcci $185 - $449 20%
Wc Fed Ex $185 - $449 20%
Wc Federal Black Lung $185 - $449 20%
Wc Federated $185 - $449 20%
Wc Finley Occupational Health $185 - $449 20%
Wc First Agency/Occunet $185 - $449 20%
Wc Ford Motor $185 - $449 20%
Wc Fresno Unified Emp $185 - $449 20%
Wc Gallagher Bassett $185 - $449 20%
Wc General Motors $185 - $449 20%
Wc Generic $185 - $449 20%
Wc Genex Care For Ohio $185 - $449 20%
Wc Great West Casualty $185 - $449 20%
Wc Guarantee Insurance $185 - $449 20%
Wc Guard Insurance Company $185 - $449 20%
Wc Hab $185 - $449 20%
Wc Hartford $185 - $449 20%
Wc Hastings $185 - $449 20%
Wc Health Management $185 - $449 20%
Wc Heritage Summit $185 - $449 20%
Wc Hireright $185 - $449 20%
Wc Horizon $185 - $449 20%
Wc Icw Group $185 - $449 20%
Wc Idaho State Ins Fund $185 - $449 20%
Wc Intercare Insurance $185 - $449 20%
Wc Intermountain $185 - $449 20%
Wc Johns Eastern $185 - $449 20%
Wc Kemberton $185 - $449 20%
Wc Key Ins & Benefit Solutions $185 - $449 20%
Wc Liberty Mutual $185 - $449 20%
Wc Mac Risk Management $185 - $449 20%
Wc Massachusetts $185 - $449 20%
Wc Mdia $185 - $449 20%
Wc Meadowbrook Claim $185 - $449 20%
Wc Medical Administrators $185 - $449 20%
Wc Meijers $185 - $449 20%
Wc Memic $185 - $449 20%
Wc Mercy Workcare $185 - $449 20%
Wc Michigan $185 - $449 20%
Wc Michigan Millers Mutual $185 - $449 20%
Wc Mitchell Frankenmuth $185 - $449 20%
Wc Mra $185 - $449 20%
Wc Nationwide $185 - $449 20%
Wc Nca Comp $185 - $449 20%
Wc New York $185 - $449 20%
Wc New York Special Funds $185 - $449 20%
Wc North American Rishces $185 - $449 20%
Wc Northeast Health $185 - $449 20%
Wc Notre Dame $185 - $449 20%
Wc Novanet $185 - $449 20%
Wc O'Hara Corp $185 - $449 20%
Wc Occ Health Allen $185 - $449 20%
Wc Ohio Bureau $185 - $449 20%
Wc One Call Medical $185 - $449 20%
Wc Paradigm $185 - $449 20%
Wc Peerless $185 - $449 20%
Wc Pma $185 - $449 20%
Wc Praxis Health Network $185 - $449 20%
Wc Price Chopper $185 - $449 20%
Wc Procura Management $185 - $449 20%
Wc Qualcare $185 - $449 20%
Wc Quiktrip $185 - $449 20%
Wc Reny Company $185 - $449 20%
Wc Rev Claims $185 - $449 20%
Wc Risico $185 - $449 20%
Wc Rural Mutual $185 - $449 20%
Wc Saif Oregon $185 - $449 20%
Wc Secura $185 - $449 20%
Wc Sedgwick $185 - $449 20%
Wc Sentry $185 - $449 20%
Wc Sheakley Unicomp $185 - $449 20%
Wc Smile Lodge $185 - $449 20%
Wc Society $185 - $449 20%
Wc Srs $185 - $449 20%
Wc Taconic (Mro) $185 - $449 20%
Wc Taconic Farms $185 - $449 20%
Wc Travelers $185 - $449 20%
Wc Triad Group $185 - $449 20%
Wc Tristar $185 - $449 20%
Wc Troy Ny $185 - $449 20%
Wc Tyson $185 - $449 20%
Wc Unified Health Services $185 - $449 20%
Wc United Heartland $185 - $449 20%
Wc Us Dept Of Labor $185 - $449 20%
Wc Velocity $185 - $449 20%
Wc Walmart $185 - $449 20%
Wc West Bend $185 - $449 20%
Wc West Bend Mutual/Argent $185 - $449 20%
Wc Winnebago Industries $185 - $449 20%
Wc Yankee Trails $185 - $449 20%
Wc York Risk $185 - $449 20%
Wc Zenith $185 - $449 20%
Wc Zurich $185 - $449 20%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 351 Sw 9Th Street, Ontario, OR 97914
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals