CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Saint Alphonsus Medical Center Ontario

Billing Code: 43239 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$142

about 0.2× the $927 Medicare rate · typically $89–$656

modeled estimate · not a bill or quote

What this hospital charges insurers

$185

Above the fair price

about $43 over the fair price · 0.2× Medicare

Medicare pays $927 Fair price $142 This hospital $185 Cash price $449 Hospital's list price $554

How we calculate the fair BaseRate →

How this hospital compares to other OR hospitals

One of the lower prices — 6 of 8 other OR hospitals charge more for the same procedure.

Cheapest $126 Priciest $349

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

A fair price for a Upper endoscopy with biopsy is about $142 (about 0.2× the $927 Medicare rate). Saint Alphonsus Medical Center Ontario charges insurers about $185, or about $449 in cash — above the fair price. Located in Ontario, OR.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $142. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

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

6 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	$54 - $393	6%
Blue Cross Blue Shieldmajor	$54 - $404	6%
Aetnamajor	$54 - $449	6%
Cignamajor	$54 - $294	6%
Humanamajor	$54 - $446	6%
Kaiser Permanentemajor	$139 - $398	15%
Ambetter (Centene)	$54 - $294	6%
Clover Health	$59 - $203	6%
Dean Health Plan	$169 - $419	18%
GEHA	$148 - $393	16%
Health Net	$54 - $449	6%
HealthPartners	$54 - $294	6%
Meridian	$54 - $294	6%
Moda Health	$132 - $361	14%
Molina	$54 - $404	6%
PacificSource	$131 - $364	14%
Paramount	$54 - $419	6%
Presbyterian	$54 - $294	6%
SelectHealth	$132 - $440	14%
Tufts Health Plan	$54 - $294	6%
WellMed	$59 - $203	6%
WellSense	$54 - $294	6%
+ 351 smaller / regional plans	$54 - $449

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

Excludes 12 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 449), 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 Saint Alphonsus Medical Center 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 Saint Alphonsus Medical Center Ontario

Compare: Upper endoscopy with biopsy at other OR hospitals

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